Permits - Permit# 12-10-85 - 2421 Black Lake Road - 1/1/1985CITY OF SPRING PARK
BUILDING PERMIT APPLICATION
BUILDING PERMIT APPLICATION REQUIREMENTS
Requirements to be handed in with Building Permit Application:
1) Building Permit Application - to be filled out & signed
2) Mechanical Permit Application & Calculation filled out.
3) Energy Calculations - filled out
d) Furnish a Certificate of Survey - if required
5) Furnish 3 sets of Construction Planes
a) 1 set for City to keep on file
b) 1 set for builder to use on site
c) 1 set for the City of Spring Park
ZONING DISTRICT
FIRE ZONE
VAR.DATE
COND. USE DATE
LOT AREA
6/a{
WIDTH. �
DEPTH r
go
PROPOSED SETBACKS
FRONT
R.SIDE NOKT-*4
REAR - rt 0,40L.SIDE
LAKE
ACCESS
4A1tCCZP
NEW
XISTI
AGENCY•APPROV. DATE
CITY
ICOUNTY
I STATE
i�
Construction Plans should include:
a) First floor plan
b) Footing & foundation plan
c) Elevations lof all sides)
d) Wall sections & cross sections
e) Details - stairs and any special eonnectic
SITE ADDRESS a Y.a..( f�L /1G,�i ��g L o
LEGAL DESCRIPTION: PROP. ID.
LOT RLOCK SUBDIVISION
OWNER
(Name) (Address) (Phone)
%h aryr 45 R La -tcGlam ,2Y21
81ceck-ta l--e �� (60)f�
ARCHITECT/ENGINEER — Must Certify Multi -Family, Commercial & Industrial Co 5
ERT.NO.
( Firm) (Address)
(Phone)
BUI LDE R
(Firm) (Address)
S 42
(Phone)
TYPE OF WOR - New Addition ^ Remodel Renovate
�i Ire /ccCe
CONST. TYPE
BLDG. SIZE
EST. CONST. VALUATION
rr
L. �2�1 W.2a.31f' Ht. 1 Spr
loon,oO
RESIDENTIAL'
STORIES O 2 3
PERMIT FEES
2 �p�rtx�MS /hGt r�
BDRMS/FLR
1 f3'droam p3�s�ml
BLDG. PERMIT -3OyQ 0
STATE FEE
PLAN REVIEW
DWELL.
UNITS
GAR. STALLS
Planning Commission b
ATT.
APP. DATE.
DET.
PENALTY
DOCK
AVAIL. CHG.
NON-RESID.
PROPOSED USE
SAC CHARGE
OCc.
CLASS.
STORIES
COUNCIL
APP. DATE
TOTAL DUE �36 , �
czse
1 �I�
REMARKS: hloN nDil/L�.P/6 As %-o o % Sim �4n/6 o9LG SeT t��9c��r s BST �ovT�_ 14
I�P�Pnri? �'p,9n/T,P� - �•eR Sec 3 - S'vdD f} �o-NoN-�oN�aR►n)►Jc i��eJS.n.rJS'. ��8
INSPECTION REQUIRED
FOOTING before pour
FRAMING rough -in
INSULATION
WALLBOARD Before Taping
F I NA L bef ore occ upancy
WORK BEYOND OR WITHOUT A RE•
OUIRED INSPECTION WILL BE SUB-
JECT TO PENALTY.
INSPECTION HOURS 473.7357
CALL 8 • 12 A.M. INSP. 1 . 4 P.M.
CALL 1 • 4 P.M. INSP. NEXT DAY
EONING CERTIFICATION
WORK REQUIRING
SEPARATE PERMITS
PLUMBING
MECHANICAL
SEWER
WATER
GRADING} & FILLING
ELECTRICAL_ from Stste
ACKNOVLEDGENENT
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE
THE REAL IMPROVEMENTS SPECIFIED,'AND DECLARES UNDER
PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPTANCE OF
ALL INFORMATION, CONDITIONS AND REQUIREMENTS REPRE•-
PRESENTED ON THIS DOCUMENT. THE UNDERSIGNED FUR—
THER AGREES TO DO ALL WORKS IN STRICT COMPLIANCE
WITH ALL CITY ORDINANCES AND STATE OF MINNESOTA
BUILDING CODE REQUIREMENTS.
S1gr.ature�%?1L4A � Date / Q
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.
authorize signature date
BUILDING CODE PLAN REVIEW
Building Official (date)
Approved Approved with Corrections Not Approved? Must be Revised
0
-y�>4'
,o 1.1.9 ,
U ' r
Description
a1.
Lot 11, ROSE LAWN
We hereby certify. that this is a .true and correct representation of a, ou;aey of -..the
boundaries of„the land' above de4c�ibed and of the location of all buildViga,- ifIraq i',-thereon
and all vizible-encroachments if ao,. from or on said lar Dated this d3►*�•..'f
_ Y•'
•_, • . �A6 ew"
.tea .11:6. •"(fi r,". - wt s;.1.•. i... • .d y,. ,L'ut•
CERTIFICATE OF SURVEY
LAND SURVEYORS
Survey for:
GARY ANDERSEN
6713 DUPONT AVENUE SOUTH
BLOOMINGTON. MINN. 55420
988.2094
M
IV