Permits - Permit# 1-11-06 - 2406 Black Lake Road - 1/1/2006CITY OF SPRING PARK
4349 WARREN AVENUE
SPRING PARK, MN 55384
952-471-9051 FAX 952-471-9160
BUILDING PERMIT APPLICATION
Building Permit Application Requirements:
1. Application to be filled out & signed
2. Mechanical Permit Application & Calculation filled out
3. Energy Calculations filled out
4. Furnish a Certificate of Survey - See Attached
5. Furnish 3 sets of Construction Plans
a) 1 set for City files
b) 1 set for builder to use on site
c) 1 set for City Building Inspector
Construction Plans should include:
1. First floor plan
2. Footing & foundation plan
3. Elevations of all sides
4. Wall sections & cross sections
5. Details -stairs & any special connections
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
THE APPLICANT IS (CIRCLE ONE)
JOB SITE ADDRESS '34/0('
OWNER OR CONTRACTOR
SF
Date Received
Date Approved
Permit No. .
Fees To Be Charged:
Permit
State Surcharge
Plan Review
SAC Charge
Availability Chrg
TOTAL
NAME OF OWNER Ral.0 4LUe S . p J3 ,Zd1N0(5 M P( Ni .,HOME PHONE WORK PHONE
MAILING ADDRESS 1 / CITY ZIP
CONTRACTOR nAz � K O).TT/, - N C�II/�1L S / _ _ PHONE �a 52 '-/ 72 S �t1 t MOBILE PHONE 6f Z 70.3 Z�-7-
MAILING ADDRESS / 6-16 i6ltt CITY A'[ W'oo ZIP 65.3 6V
STATE LICENSE NO. P-01(0 Z1'
ARCHITECTIENGINEER Pee P kJ 4J01C<,p I�i' PHONE �" S 5 / J6 I Z
MAILING ADDRESS �ylo A Al CITY ZIP 55- �� 6
NAME
REGISTRATION NO.
TYPE OF WORK: NEW P ADDITION ACCESSORY STRUCTURE MOVE DEMO
REMODELIALTERATION RENOVATE
PROPOSED WORK (Describe in Detain
LAND ALTERATION
a/I/
ZONING DISTRICT I�
STORIES �_ SM FEET OR EACH FLOOR NO.OF BEDROOMS GARAGE STALLS 2-
ATTACHED � OR DETACHED BLDG. SIZE: LENGTH WIDTH 30 HEIGHT 0'9!re�
ESTIMATED CONSTRUCTION VALUATION (excluding land) $ 2CO) a�0 f�
%6 Z
6 4 /110-td-t-
BUILDING PERMIT APPLICATION
PAGE 2
HARDCOVER CALCULATION WORKSHEET
Haase
cp ---
AREAS
House/Garage
1260 Sq.Ft.
,fie"
Drive/Walk
In
908 Sq.Ft.
Wrap —around Deck
129 Sq.Ft.
Front Deck beyond Gar.
38 Sq.Ft.
Total Hardcover
2335 Sq.Ft.
Lot Area
6882 Sq.Ft.
X of Hardcover =
33.9 %
-7Z0 S.F.
O S.F.
S.F.
S.F.
it
S.F.
S.F.
S.F.
i S.F.
S.F.
S.F.
- - - S.F.
1 DIVIDED BY 2 X 100 = %
I hereby apply for a building permit and I acknowledge that the Information above Is complete and accurate; that the work will be In conformance
with the ordinances and codes of the City and with the State Building Code; that I understand this is not a permit and work Is not to start without
a permit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE DATE Z / F
/ot�'
INSPECTION REQUIRED: WORK REQUIRING SEPARATE PERMITS:
Footing before a? Plumbing
Framing rough -in Mechanical
Insulation Well
Wallboard before taping Grading & filling
FINAL before occupancy Sewer
Water
WORK BEYOND OR WITHOUT A REQUIRED
INSPECTION WILL BE SUBJECT TO PENALTY Electrical from State
24 HOUR NOTICE REQUIRED CALL 952-249-4600
ZONING CERTIFICATE
I do hereby certify to the Orono Building Official that the following described work has been reviewed for
compliance with the Zoning Requirements of the City of Spring Park and will be approved for construction upon
approval of the construction plans by the Building Official.
Name
a IJ -► :_ -
Date
Name Date