Permits - Permit# 05-03 - 2424 Black Lake Road - 1/1/2005• CITY OF SPRING PARK
4349 WARREN; AVEN U E
SPRING PARK,<MN 55384�
952-471-9051 FAX 952-471-9160
BUILDING PERM APPLICATION
Building Permit Application Requirements: Date Received
1. Application to be filled out & signed Date Approved 1 Os/oS
2. Mechanical Permit Application & Calculation filled out Permit No. 42.S'a3
3. Energy Calculations filled out
4. Furnish a Certificate of Survey - See Attached
5. Furnish 3 sets of Construction Plans Fees To Be Charged:
a)1 set for City files Permit
b)1 set for builder to use on site State Surcharge Zs10-o
c)1 set for City Building Inspector Plan Review Lfl '3 .4 4
Construction Plans should include: SAC Charge
1. First floor plan Availability Chrg
2. Footing & foundation plan
3. Elevations of all sides TOTAL J1 0 7 . I Ci
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 CONTRACTOR
JOB SITE ADDRESS —
NAME OF OWNER 3On O Se rl
HOME PHONE y 71 ''14E WORK PHONE
MAILING ADDRESS 21 Z!A &lack 19. %1L,
CITY' r i ►E� V-, ZIP ";is 3 $,I
CONTRACTOR
PHONE *71- 'i iq MOBILE PHONE Scan e_
MAILING ADDRESS 2 Li J� t a.c k L K;'Rd
CITY S(dr I A e?u rr k ZIP
STATE LICENSE NO.
ARCHITECTIE14GINEER A a LL ie.(' T) e 5 i c{ r) C p
r a Ne-\ ecr_ PHONE 1�() If( cI - 301 Z
MAILINGADDRESS 94sD agxn Cir<Ae-
CITY [—cEa'?MirIL YW ZIP 66341
NAME If uCe lee kI i e-f
REGISTRATION NO.
TYPE OF WORK: NEW ADDITION _ ACCESSORY
STRUCTURE MOVE DEMO _�Y,
REMODEUALTERATION RENOVATE
LAND ALTERATION
//1� t�
PROPOSED WORK (Describe In Detail) AA(K,� -s CO �1CA
S` !`�! �' `A S tg,-8 r 6 S M k
ZONING DISTRICT STORIES 1 LA� SO. FEET OR EACH FLOOR '3q� `� NO. OF BEDROOMS I GARAGE STALLS
ATTACHED OR DETACHED BLDG. SIZE: LENGTH 2-0 WIDTH 2-Z ' HEIGHT
ESTIMATED CONSTRUCTION VALUATION (excluding land) $ 'JO. Vce , '
BUILjDING PERMIT APPLICATION
PAGE 2
HARDCOVER CALCULATION WORKSHEET
A. House X = S.F.
Length Width
X = S.F.
py
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 = %
1 hereby apply for a building permit and I acknowledge that the Infonnatlori 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 •�rca.DATE / Z
INSPECTION REQUIRED: WORD REQUIRING SEPARATE PERMITS:
Footing before a pour ✓ Plumbing
_Framing rough -in ✓ _Mechanical
Insulation Well
Of Wallboard before taping Grading & filling
t� FINAL before occupancy Sewer
WORK BEYOND OR WITHOUT A REQUIRED Water
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 Date
Date I-
s'
F.,...., IV.. 99Q tl n 1 i i n + n n t; n non Election Systems and Software 1-800-800-8225 .
Permit 643.75
State 25.00
-Pl- -R-e v • • . •41.8 --44
Total 1,087.19
,NII...05:03.....:.
tle Df Ninny ota, C i.ty...... of. S o r. i n g . P., r. k ...........
County of..Hgnrieei�1 .............. Office of ..Poi.l.dinq Irk pector
Nut-lbing 'piermat
IN CONSIDERATION OF The statements and representations made by ......................
Ron 01son
................................................,....................................................
in application therefor duly filed in this office, which application is hereby made a part hereof, PERMISSION IS HEREBY
GRANTED To said ......?o" 01'()t ............................ as owner
.......................................
to . �dd..211d Stur ..(. edroola and bathroom) oer aopl 1catioil ............................. a building described as follows: kind of construction
(build, erect, install, add to, alter, repair, move, wreck, as the case may be)
.....................................................................................................
front or width in feet ................ : side or length in feet ................ ; height in feet ................
number of stories ............... : contents ............... cubic feet; ........... , ... square feet, upon that
tract of land described as follows: Lot ................ Block ................ ; plat or addition .................
2424 Black Lake Road 19-117-23-12-0007
....................................................................................................
which tract is of the size and area specified in said application.
This permit is granted upon the express conditions that said owner and h . J.S. contractors, agents, workers and
employees, shall comply in all respects with the ordinances of the .. C i ty. . ............ of S or i n g Park ;
that it does not cover the use of public property, such as streets, sidewalks, alleys, etc., for which special permits must
be secured; and that it does not cover the following: None of the f o l l ot: i n g
(Electrical work, plumbing, heating, plastering, etc., if such there be.)
for which special permits must be secured. .
Given under the hand of the B,,.J 1 di na. ,I!1,s,pector , , of said ..Qi.t� .... and its corporate seal and
Clerk 7th January
attested by its this ....................... day of . Jan ..............Year. , 2 00.5 . .
.......................
Attest:
..........Will ia111 D: Weeks..../ .4. \......... ........l...On1a ...... ...�..... ............. .
Clerk B!Jilding Insrlector
........................ ........................