Permits - Permit# 02-08 - 2425 Black Lake Road - 1/1/2002CITY OF SPRING PARK
4 - P. 0. BOX 452
4349 WARREN AVENUE
SPRING PARK, MN 55384
952-471-9051 FAX 952-471-9160
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
5. 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 & 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 CONTRACTOR
JOB SITE ADDRESS
NAME OF OWNER_ C-C, & !U E6IC(-TOME PHO
MAILING ADDRESS
CONTRACTOR
SI VQ ) CITY
MAILING ADDRESS6 `7'!/aC) d 6 -[ r% 14ae CITY
STATE LICENSE NO. Q?Q2 -;3q aS M O # d&AK%- `f
Date Received
Date Approved e=�
Permit No. U
Fees To Be Charged:
Permit
State Surcharge -F, e a
Plan Review
SAC Charge
Availability Chrg
TOTAL 1.4 r.11)
/ 9- /i-2 9 - /,.;t -pig 7
V4 . RK PHONE
ZIP
07 MOBILE PHONE
PA_ ZIP
9-A-� QrLU i-e - (743) fit. l-e3 0
ARCHITECTIENGINEER )-) 4- PHONE
MAILING ADDRESS
CITY
ZIP
NAME REGISTRATION NO.
TYPE OF WORK: NEW ADDITION ACCESSORY STRUCTURE MOVE DEMO
REMODELIALTERATION X' RENOVATE LAND ALTERATION
PROPOSED WORK (Describe in Detail) &W CW1 -vim �DiYY! �G y — ".,s (X�Y ifC ✓u'
A
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) $ �(p� q. 60
aui�urn
"RAG1= 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 a ante with the ap ved plan. p
APPLICANT'S SIGNATURE (/Yv�� DATE
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 �i(�h. ems���i/o y
� Date I/o ;2—
BUILDING CODE PLAN REVIEW
Name Date
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FormNo.259 Valiaation $5609
Election Systems and Software 1-800-800-8225-
Perili t $ 125.25
State $ 3.00
... Total ... $ 128•.25
02 08
#tate of Minnesota, C i t.y of S r, r i n g Park
...............
County of .... Henneni,i B0�ng
............ Office of ..:.il..di...........Inspector .............
1N CONSIDERATION ON The statements and representations made by ......................
Window Lite Horde Improvement
....................................................................................................
in application therefor duly filed in this office, which application is hereby made a part hereof, PERMISSION IS HEREBY
GRANTED To said .......Wi.rtcio.%q .Li.te .Ko.iijQ .Igpruv.elnent ...... . . ... . . . ...... . ...... . .... . ........ as owner
to .... BdLhr.QU!I."e1i11?del , per, n.put.iCati0)n........................a building described as follows: kind of construction
(build, erect, install, add to, alter, repair, move, wreck, as the case may bet
....................................................................................................
front or width in feet ................ : side or length in feel ................ ; height in feet ................
number of stories ............... : contents ............... cubic; feel; ............... square feet, upon that
tract of land described as follows: Lot ................ Block ................ ; plat or addition ................
2425 Black Lake Road 19-117-23-12-0127
....................................................................................................
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 i s.. contractors, agents, workers and
employees, shall comply in all respects with the ordinances of the ... CJ t.Y............. of . Sori n9 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: ....... Nop.e of the .� of 1 ow'i rlg
(Electrical work, plurnhing. heating, plastering, etc., if such there be.)
for which special permits must be secured.
Given under the hand of the 13,jildin9. In.;oectt)r of said Ci :�' and its corporate seal and
attested by its ....Clerk .............. this ...2.2.i.................. (lay of .. March hiur•.200.
Attest:
William, D. Weeks
.......... .. ......... �.....
Clerk
........................
Lyle Olean
......................... I.................
B-:ilding Inspector
........................