Permits - Permit# SP14-027 - 2412 Black Lake Road - 1/1/2014f l
I I
CONTACT NAME - PHONE - EMAIL - FAX a G, grz ?,-j7 30
CONTRACTOR LICENSE #
TYPE OF WORK -_
o New Home
❑Deck
❑ Commercial t _ Residential
❑ Addition
❑ Fence Height:
❑ Re -Side
(EST: VA L TIO_ N=,O_PWORK
❑ Remodel
❑ Pool
❑ Ret. Wall Height:
$ &&Gdi
❑ Finish Basement
❑ Stucco Demo
❑ Window Replacement
Building Height: Feet
o Accesso Structure
❑ Stucco
❑ Other:
# of Stories:
SCOPE OF WORK: 1
Use of Building:fro
CG✓J fir-rJ�J �j2
_
ignsture of this Opp= by the legal property owner or a licensed contractor, as the ownees representative is requtretl and authorises vie City Zoning Administrator or designee and the City Building Official or designee
to enter upon the property to perform needed Inspections. Fntry may be without prior notice. I hereby adurowledge that I have read this application and state that all hdormatlon Is bus and Na
correct to best of my
knowledge- I further agree that es work performed will be in accordance with approved plans, apecKcetions and conditions and to abide by 00 ordinances of the City and the laws of the State of Minnesota regarding salons
pursuarrt to this permit 1 agree to pay all plan revlew fees even It 1 choose not to proceed with the work Permit expires when work Is not commenced with 180 days from date of issued, If building
permit or and
work Is suspended. abandoned or not Inspected for 180 days. Work beyond or without a permit or Inspection wig be subject to a Welty.
Call MNSPECT for inspection at (952 442-7520 24 Hour Notice) e:00 a.m. - 4:30 p.m. / 1/
SIGNATURE OF APPLICANT: - DATE: �CiCTfi - -
PRINTED NAME: C ns'd� ` DATE: -
LEGAL DESCRIPTION Lot Block Addition Zoning
Valuation of Permit: $ ILot Area: l
OCCUP. TYPE: CONST. TYPE: CODE: BLDG SPRINKLED
Yes I No
SETBACKS: REQUIRED jft1j- ACTUAL (ft) _- Permit Fee.$
Front ROW -- --
- - -- -- - - - 'NOTE: Commercial plans will .-- Plan Check Fee:$
Rear - ---
- -- - -- --- -- �--� - ------ - -- be Submited to the Met _ State Surcharge_$ S.100
Side
Council Errvironmenlal Svcs Site Insp. Fees
Side _ _ for SAC (sewer availability Muni SE/WA Fee:$ __._.._..
---
Comer-
_ _ _ Charge) determination. S.E.0 Fee:$
_
Lakeshore �-T - Escrow payment will be '20.3 SAC Escrow 52;435
Wetland _ required when permit is
WAC Charge:$ — -- -
_
Other issued. If after Met Council sewa, a H@o Hook-up:$ ---
review no SAC is determined, — - - -
i9wow will be refunded in full'. Sewer 8 HZp Dsconnea:$
Water Meter.$
Paid Receipt No. "other:
Date g - - -
TOTAL DUE::$
BUILDING APPROVAL BY. j DAT
- - — - - - - TIME
CITYAPPROVAL BY: iDAT .
TIME:
All new construction andlor dwelling expansion shall require a certified survey dated within five years of application.
-- --.. .- -- - -- ---------
All new construction andlor dwelling expansion will be subject to contracted planner review and may add to the . --w reviet-ime.
.J %
Minnesota Department of Labor and Industry
Construction Codes and Licensing Division
443 Lafayette Road N
Saint Paul, MN 55155
NOTICES
NOT TRANSFERABLE
CHANGE YOUR BUSINESS STRUCTURE
SUBMIT A NEW APPLICATION FOR NEW ENTITY
RENEW OR REPLACE INSURANCE POLICY
SUBMIT NEW CERTIFICATE OF INSURANCE
Licensing and Certification Services
Phone: 651.284.5034
Email: DU.Ucense@state.mn.us
Website: www.dii.mn.gov/ccid.asp
TONKA PROPERTY MANAGEMENT LLC
DBA TONKA ROOFING
16725 CANTERBURY DR
MINNETONKA, MN 55345
NOTIFY THE DEPARTMENT OF A CHANGE IN YOUR BUSINESS.
Failure to do so, subjects you to administrative penalties of up to $10,000.
15-Day Notice Requirement — Forms available online at www.dli.mn.cloy/CCLD/LicUpdate.asp
• Change in business' physical address, mailing address, phone number, or email address
• Change in control, owners, officers, directors, members, partners
• Change in business' legal name and/or assumed name
• Loss of or change in QUALIFYING REMODELER
• Change in general liability insurance or workers' compensation insurance coverage
Immediate Notice Requirement — Notification to OU in writing
Judgment Debtor. A licensed contractor has 15 days to provide written notice of the finding that it is found to be a judgment
debtor based upon conduct requiring licensure.
Bankruptcy Petition Fled. A licensed contractor has 15 days to provide written notice that it filed a petition for bankruptcy.
Conviction Notice. A licensed contractor has 10 days to provide written notice that it has been found guilty of a felony, gross
misdemeanor, misdemeanor or any comparable offense related to the license, including convictions of fraud,
misrepresentation, misuse of funds, theft, criminal sexual conduct, assault, burglary, conversion of funds, or theft of proceeds
in this or any other state or any other United States jurisdiction.
YOUR CERTIFICATE IS BELOW THE PERFORATION. SHOW CERTIFICATE WHEN OBTAINING PERMITS.
'kdft
UM14ESOTA13EPAW MEMTOF
ABOR & INDUSTRY
Construction Codes and Licensing Division
WeWte: www.d6.nm.aw/ocktasy
RESIDENTIAL REMODELER
Licensing and Cefification Services 443 Lafayette Road N St. Paul. MN 55155
Email: dli.licensefHislate.nm.us Phone: 651.284.5034
This is to certify that the certificate holder is licensed as a RESIDENTIAL REMODELER in the state of Minnesota and is in compliance with
Minnesota Statutes 32613.805, and may contract or offer to contract with an owner to improve existing residential real estate; provided the
responsible individual is at all times a QUALIFYING REMODELER and the certificate holder maintains compliance with the required bond,
general liability insurance, and workers' compensation laws.
License : RESIDENTIAL REMODELER
Lie Number : CR586668 TONKA PROPERTY MANAGEMENT LLC
Effective Date : 04/01/2014 DBA TONKA ROOFING
Expiration Date : 03/31/2016 16725 CANTERBURY DR
MINNETONKA, MN 55345
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VERIFY UPI -TO -DATE STATUS, BOND, AND INSURANCE INFO AT www.dli.mn.gov/ccld/LicVerify.aso (ENTER NUMBER).