Permits - Permit# 11-34B - 2413 Black Lake Road - 1/1/2011CITY OF SPRING PARK
4349 Warren Avenue Spring Park, MN 55384
Phone (952) 471-9051 Fax (952) 471-9160
BUILDING PERMIT
Noise Ordinance In Effect:
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Monday - Friday before 7 a.m.
and after 10 p.m.
Weekends/Holidays before 7
a.m. and after 8 p.m.
DATE GJ . Gj _ ((
CHANGES TO APPROVED BUILDING PLANS MUST HAVE CITY APPROVAL
SITE ADDRESS c.( (3 4 c "ID
OWNER Name /Address/ City/ State /Zio
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CONTACT NAME - PHONE - EMAIL - FAX
ARCHITECT (if Reguired) Name / Add i
CONTRACTOR
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CONTACT NAME - PHONE - EMAIL -
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CONTRACTOR LICENSE #
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TYPE OF WORK
❑ New Home
❑ Deck
❑ Re -Roof
❑ Commercial esidential
❑ Addition
❑ Fence Height:
❑ Re -Side
EST. VALUATION OF WORK
❑ Remodel
❑ Pool
❑ Ret. Wall Height:
$
❑ Finish Basement
❑ Stucco Demo
indow Replacement
Building Height: Feet
❑ Accessory Structure
❑ Stucco
ther: Vu6 - J e 14 c' ^
# of Stories:
SCOPE OF WORK:
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Use of Building:
Signature of this application by the legal property owner or a licensed contractor, as the owner's representative is required and authorizes the City Zoning Administrator or designee and the City 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 state 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 City and the laws of the State of Minnesota regarding actions
taken pursuant to this permit. I agree to pay all plan review fees even If 1 choose not to proceed with the work Permit expires when work is not commenced with 180 days from date of permit issued, or If building and
work is suspended, abandoned or not Inspected for 180 days. Work beyond or wqt a permit or inspection will be subject to a penally.
Call MNSPECT for inspections of 02 442-7520. (24 Hour Notice) 8:00 a.m. - 4:30 p.m.
SIGNATURE OF APPLICANT:
DATE:
PRINTED NAME:
^
P v.
DATE:
LEGAL DESCRIPTION: Lot Block Addition Zoning
Valuation of Permit: $
ILot Area:
OCCUP. TYPE: CONST. TYPE: CODE: BLDG SPRINKLED Yes / No
SETBACKS: REQUIRED ft
ACTUAL (ft)
NOTE: Commercial plans will
be st>timited to the Met
Council Environmental Svcs
for SAC (sewer availability
charge) determination.
Escrow payment will be
required when pew is
issued. If after Met Council
review n0 SAC is determined.
escrow will be refunded in full.
Permit Fee:$
Front(ROW)
Plan Check Fee:$
State Surcharge:$ S _
Rear
Side
Site Insp. Fee:$
Side
Muni SE/WA Fee:$
Comer
S.E.0 Fee:$
Lakeshore
*2011 SAC Escrow :$Z230
Wetland
WAC Charge:$
Other
Sewer & H2O Hook -Up:$
Sewer & H2O Disconnect:$
Water Meter.$
Paid
Receipt No.
other:$
Date
B
TOTAL DUE:
$
BUILDING APPROVAL BY.
DATE:
TIME.
CITYAPPROVAL BY.,
DATE:
TIME:
All new construction and/or dwelling expansion shall require a certified survey dated within five years of application.
All new construction and/or dwelling expansion will be subject to contracted planner review and may add to the review time.
legal Nsme pgOyE ALL CONSTRUCTION INC Business Structure:
SBA CORPORATION