Permits - Permit# 26SP-00052 - 3946 Shoreline Drive - 6/2/2026CITY OF SPRING PARK
BUILDING PERMIT
4349 Warren Avenue
SAGE 1
Spring Park, MN 55384
Email completed form to City of
Spring Park to the attention of;
Phone: 952-471-9051
jkhoffman@ci.spring-park.mn.us
Routed to SAFEbuilt
Email: jkhoffmanQci.spring-park.mn.us
SITE ADDRESS: 3946 Shoreline Drive Spring Park MN 55384 PID:
1) Was the home constructed before 1978? (YESD, continue with line 2, NO ❑ continue without completing EPA Section)
2) Will the work disturb z6 sq ft of interior painted surfaces or 2!20
sq ft of exterior painted surfaces? (YES ❑ go to line 4, NODline 3)
3) Are there any windows being replaced? (YES ❑, go to line 4, NOE7continue
without completing EPA Section)
4) Has this home been Certified Lead Free? (YES ❑ , you MUST Attach Certification Information, NO ❑ complete line 5)
5) EPA Contractor Certification Number: NAT - 250344
PROPERTY OWNER: Anton Reder
Address: 3946 Shoreline Drive
city: Spring lake state: MN zip: 55384
Email: permits@selaroofing.com
Contact Name: Sela
Phone: 612 823 8046
CONTRACTOR: Sela Roofing and Remodeling
Address: 4521 MN 7
city: St Louis Park State: MN zip: 55416
Phone: Fax:
Contractor License No: CRO01050
Contact Name: Phone:
Email:
ARCHITECT:
Address:
City: State: M N zip:
Phone: Fax:
Email:
Contact Name: Pho e:
TYPE OF WORK: []New Construction
[]Deck -Roof
❑Commercial Residential []Change of Use
[]Pool Re -Side
EST. VALUATION OF
_IQIORK []Finish Basement
❑Retaining Wall ❑Fence
$ `� 16 c () ❑Remodel
❑Porch []Shed sq ft
Square feet: ❑Addition
[]Demolition ❑Window/Door Replacement
qy ❑Garage-Attached/Detach []Plumbing -provide detail on Page 2 # being replaced
Detailed Description of Work: ❑Accessory Structure
[]Mechanical -provide detail on Page 2 ❑Misc Other
REROOF HOUSE, no flats
Signature of this application by the legal property owner or a licensed contractor, as the owners representative, is required and authorizes the Zoning Administrator or designee and the Building
Official or designee to enter upon the property to perform needed inspections. Entry may be without prior notice. I hereby acknowledge that I have read this application and stale that all information
is true and correct to the best of my knowledge. I further agree that all work performed will be
in accordance with approved plans, specifications and conditions and to abide by all ordinances of the
Municipality and the laws of the State of Minnesota regarding act' taken pursuant to this permit. I agree to pay all plan review fees even If I choose not to proceed with the work. Permit
expires when work is not commenced within pl7aV from a of ermil, or if wor ' uspended, abandoned, or not inspected for 180 days. Work beyond the scope of this permit, or work without
a ermit or inspection, will be subject to a nalt .
SIGNATURE OF APPLICA :
DATE: 6/2/2026
PRINTED NAME: Nessa
This is the signature of: []Owner or []Owner's Representative
OCCUP. TYPE: CONST. TYPE: CODE:
BLDG SPRINKLED Yes / No
VALUATION: $
Permit Fee: $
Park Dedication: $
Plan Review Fee: $
SAC Charge: $
State Surcharge: $
WAC Charge: $
Site Inspection Fee: $
Sewer Hook -Up: $
S.E.C. Fee: $
Water Hook -Up: $
Investigation Fee / Other Fee: $
Sewer Trunk: $
Copy Charge ($.25 per 8.5x11 page) $
Water Trunk: $
p
License Check ($5) / Lead Check ($5) $
Water Meter $
co
SUB -TOTAL $
SAC or City Fee:$
D
Plumbing Fee (from Page 2) $
Other: $
v
Mechanical Fee (from Page 2) $
TOTAL DUE: $
LL
Special Conditions/Required Setbacks:
O
Building Approval By:
DATE:
Printed Building Approval By:
❑ License Verification ❑ Lead Verification - Checked By:
City Approval By:
DATE:
Paid: Date: Receipt No.
By:
CITY OF SPRING PARK ❑ MECHANICAL PERMIT
❑ PLUMBING PERMIT
PAGE 2 FOR PERMIT ISSUANCE
PAGE 1 and PAGE 2 should be complete
MECHANICAL INFORMATION
Mechanical Contractor: Address:
City: State: Zip: Phone: Fax:
State Bond No:
Contact Name:
Email:
Contact Phone:
Detailed Description of Work:
Indicate type of project, fixtures, and Gas Lines you will be installing or replacing (include count for each type of fixture):
MECHANICAL FIXTURES GAS LINES
Quantity Quantity Quantity
Furnace Kitchen Fan Furnace
Air Conditioning System Bath Fan Fireplace
Air Exchanger Grill Unit Heater
Fireplace Water Heater
Unit Heater Grill
In Floor Heat Dryer
Gas Log Stove
Office Use Only:
❑ Replacement (one fixture only, no piping or vent changes) Mechanical Permit Fee: $
❑ Addition/Remodel Gas Line Permit Fee: $
❑ New Construction State Surcharge: $ 1.00
❑ Other Other: $
Total Mechanical Permit: $
PLUMBING INFORMATION
Plumbing Contractor: Address:
City: State: Zip: Phone: Fax:
Plumbers License No:
IState Bond No:
Contact Name: I
Contact Phone:
Email:
Detailed Description of Work:
Indicate type of project and fixtures you will be installing or replacing (include count for each type of fixture):
PLUMBING FIXTURES
Quantity Quantity Quantity
Water Heater Shower Laundry Tub
❑Gas ❑Electric Dishwasher Rough -in Future Fixture
Water Softener Clothes Washer Sump
Lawn Sprinkler System Ice Maker Line Water Piping System
Water Closet (Toilet) Hose Bib Floor Drain
Lavatory Wash Basin Bathtub
Office Use Only:
❑Replacement (one fixture only, no piping or vent changes)
Plumbing Permit Fee: $
❑Addition/Remodel
State Surcharge $ 1.00
❑New Construction
Other: $
❑Other
Total Plumbing Permit: $