Permits - Permit# 99-42 - 2421 Black Lake Road - 1/1/1999 (2)CITY OF SPRING PARK
P. O. BOX 452
SPRING PARK, MN 55384
471-9051 FAX 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
S. 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 8 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) OWNER OR
I
JOB SITE ADDRESS r9411 INC
NAME OF OWNER �
CONTRACTOR
Date Received o/aa�9 9
Date Approved �� 4
Permit No. c75;i-4/21
Fees To Be Charged:
Permit
State Surcharge a ad
Plan Review
SAC Charge
Availability Chrg
TOTAL g-g. -5
:11- /� 7- // ";-.; 3 -
PHONE (DA / `1)Q J7 / WORK F
MAILING ADDRESS L�j'7/ �`��`-'�` CITY I� itAn
AkkyyL
�7M ZIP C J �J ZJ�
CONTRACTOR l �l 1 S PHONE 10/ Q i /V /(- V MOBILE PHONE
p
MAILING ADDRESS V Lu `l TL U iJ CITY f � r-aa l W 1 `I5 ZIP
STATE LICENSE NO.
ARCHITECT/ENGINEER
MAILING ADDRESS
NAME
CITY
REGISTRATION NO.
PHONE
ZIP
TYPE OF WORK: NEW ADDITION ACCESSORY STRUCTURE MOVE DEMO
REMODELIALTERATION REN�ATE/'� LAND ALTERATION
PROPOSED WORK (Describe in Detail) IYin y , 1 ' 5f t i I II�VU
ZONING DISTRICT
STORIES SQ. FEET OR EACH FLOOR NO. OF BEDROOMS GARAGE STALLS
ATTACHED OR DETACHED BLDG. SIZE: LENGTH WIDTH HEIGHT
ESTIMATED CONSTRUCTION VALUATION (excluding land) $ l�l-CJ
i 9 -O l 4:70
BUiLRING PERMIT APPLICATION
PAGE 2
HARDCOVER CALCULATION WORKSHEET
A. House X = S.F.
Length Width
X = S.F.
B. Garage X = S.F.
C. Driveway X = S.F.
X = S.F.
D. Sidewalk X = S.F.
X = S.F.
E. Patio/Deck X = S.F.
F. Other X = S.F.
1. TOTAL HARDCOVER S.F.
2. TOTAL PROPERTY AREA 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 11,1 aL� U' V W J DATE QPM
INSPECTION REQUIRED: WORK REQUIRING SEPARATE PERMITS:
Footing before a pour 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 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 Date
BUILDING CODE PLAN REVIEW
Name
Date