Permits - Permit# 10-11B - 2425 Black Lake Road - 1/1/2010CITY OF SPRING PARK
4349 WARREN AVENUE
SPRING PARK, MN 55384
952-471-9051 FAX 952-471-9160
BUILDING PERMIT APPLICATION
Building Permit Application Requirements:
Date Received D/d
1. Application to be filled out & signed
Date Approved
2. Mechanical Permit Application & Calculation filled out
Permit No.
3. Energy Calculations filled out
4. Furnish a Certificate of Survey - See Attached
5. Furnish 3 sets of Construction Plans
Fees To Be Charged: Yj S O
a) 1 set for City files
Permit
b) 1 set for builder to use on site
State Surcharge "" U
c) 1 set for City Building Inspector
Plan Review
Construction Plans should include:
SAC Charge
1. First floor plan
Availability Chrg
2. Footing & foundation plan
jl
3. Elevations of all sides
TOTAL
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)
JOB SITE ADDRESS
NAME OF OWNER
MAILING ADDRESS
OME PHONE %�f - -I�I WORK PI
CITY ZIP
CONTRACTOR Renewal By Andersen MOBILE PHONE
OWNER OR
k1V�. SS
1920 County Road "C" West
MAILING ADDRESS _
Roseville, MN 55113
STATE LICENSE NO. _
License 420130983
651-264-4777
ARCHITECT/ENGINEEn
_ _._ PHONE
MAILING ADDRESS
CITY
NAME
REGISTRATION NO.
TYPE OF WORK: NEW ADDITION
REMODEL/ALTERATION _
PROPOSED WORK (Describe in Detail)
4'01au / O t,vi r\,A G
ZONING DISTRICT
ACCESSORY STRUCTURE MOVE
RENOVATE LAND ALTERATION
ZIP
ZIP
DEMO
w
STORIES SQ. FEET OR EACH FLOOR NO. OF BEDROOMS GARAGE STALLS
ATTACHED OR DETACHED BLDG. SIZE: LENGTH WIDTH HEIGHT
✓
ESTIMATED CONSTRUCTION VALUATION (excluding land) $ I (51 aa *
BUILDING 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.
l 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 Stale 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 appr ed plan.
APPLICANT'S SIGNATUREAl—VDATE v
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 95�� % 20
ZONING CERTIFICATE
I do hereby certify to the Ora>ffBuilding 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
Permit #: 10-11 B
City of Spring Park
4349 Warren Avenue, Spring Park, MN 55384
Building Permit
PINS: 19-117-23-12-0127 ADDRESS: 2425 Black Lake Road
Permission is hereby granted to: Renewal by Andersen/Andrea Schussler
To install or construct the improvements applied for. This permit is granted upon the condition that
the person to whom it is granted, and his agents, employees and workmen, shall conform in all
respects to the Ordinances of the City of Spring Park and to the Statutes of the State of Minnesota in
such cases made and provided; this permit may be revoked at any time upon violation of any of the
provisions of said Ordinances, Statutes, or for any misrepresentation in the application.
Approved by MNSPECT, CBO
Date: June 2, 2010
NOTE: This card must be placed in a conspicuous place at the address which work is to be
performed.
CITY OF SPRING PARK
4349 Warren Avenue, Spring Park, MN 55384
INSPECTION RECORD
PINS 19-117-23-12-0127
Building Inspections — Permit No. 10-11 B
Footings
Date
Inspector
Framing
Insulation
Wallboard B-4 taping
Final X
Others
ADDRESS: 2425 Black Lake Road
Plumbing Inspections — Permit #
Date Inspector
Rough -in
Air Test
Final
Permit #
Date
Inspector
Sewer
Water
Electric
Note: Contractor is responsible to call for these inspections. This card must be placed in
a conspicuous place, on the premises on which work is to be performed. 952-442-7520.
re
BY ANDERSEN
,;nd, , ,, 1,1.,, vn,,,,,
al MAY 2 2 2010
W S & D Permit Service
9533 - 367i1' Street: North Branch, MN 55056
Phone 651-674-1766 - Fax: 651-674-6190
I o Whom It k1a\ Concern:
I Lim an authorii.cd agent b\ Renewal by Andersen to pull. pa- tor. and obtain their building=
permits. I have cnciused a seltaddressed stamped envelope Ior you convenience to mail the
permit back to mc. I I' there is a problem with this please I'ecl tree to uive me a call at
O; I -0 7 4-1 7 60.
I hank %'OLI for you assistance-.
Kara 13cnum
WS&,D Permit Service
65 1 -6 74- 1 766 Phonc
61 -674-0 190 - I- ;Ix