Permits - Permit# SP17-021 - 2429 Black Lake Road - 1/1/2017CITY OF SPRING PARK
PAGE 1 BUILDING PERMIT
4349 Warren Avenue
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Spring Park, MN 55384
L,�P Handout Given (J
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Phone: 952-471-9051 Fax: 952-471-9160
Lead Handout Given
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SITE ADDRESS:,, /,2/ [/
/ PID:
1) Was the home constructed before 1978? (YES ❑, continue with line 2, NO ❑ continue without completing EPA Section)
2) Will the work disturb 26 sq ft of interior painted surfaces or Z20
sq ft of exterior painted surfaces? (YES ❑ go to line 4, NO ❑ line 3)
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3) Are there any windows being replaced? (YES ❑, go to line 4, NO ❑ continue without completing EPA Section)
4) Has this home been Certified Lead Free? (YES ❑, you MUST Attach Certification Information, NO ❑ complete line 5)
5) EPA Contractor Certification Number. NAT - / DOS (o 0
_ (applies to contractor only)
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PROPERTY LJ�iI /Zi,0 LC�%Z7
Address: 9 C/2 !� J%b
"OWNER:
City-_4'rfi /jf State: Zip:
Email:
Contact Name: j2 ( R,:j-p i_a O
Phone: / Z Z/0 6evg'
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CONTRACTOR: CAF-
Address: 4eGdJ Le- v RD
Ci PLC PLAIIJ State•e� Zip: ��j
Phone: /Z Z75 2-74-7 Fax:
Contractor License No: e'-3 it k 9
Contact Name: /LS(fFft/D/YNPhone: /L'.L7S��7
Email: /1)k£5 C' '4'oo-& . c t,
ARCHITECT:
Address:
City: State: Zip:
Phone: Fax:
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Email:
Contact Name: Phone:
TYPE OF WORK:
❑ New Construction
In Deck In Re -Roof
❑ Commercial Residential
❑ Change of Use
❑ Finish Basement
❑ Pool ❑ Re -Side
❑ Retaining Wall ❑ Fence
EST. VALUATION OF WORK
$
❑ Remodel
❑ Porch ❑ Shed
Square feet.
❑ Addition
❑ Demolition ❑ Window/Door Replacement
❑ Garage-Attached/Detach
❑ Accessory Structure
❑ Plumbing -provide detail on Page 2 # being replaced
❑ Mechanical -provide detail on Page 2 isc Other /4i/L5
Detailed Description of Work:
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Signature of this application by the legal property owner or a licensed contractor, as the owner's representative, is required and authorizes the Zoning Administrator or designee and the Building Official
or designee to enter upon the property to perform needed inspections. Entry may be without prior notice. I hereby acknowledge that I have read this application and state that all Information is true and
coned to the best of my knowledge. 1 further agree that all work performed will be In accordance with approved plans, specifications and conditions and to abide by all ordinances of the Municipality,
and the laws of the State of Minnesota regarding actions taken pursuant to this permit. 1 agree
to pay at plan review fees even If I choose not to proceed with the work. Pemdt expires when work
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is not commenced within 180 days from date of permit or if work is suspended, abandoned, or
not inspected for 180 days. Work beyond the scope of this permit, or work without a permit or Inspection,
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1 be subject to a penalty.
Noise Ordinance In Effect: M 22DAY - FRIDAY Before 7 am.
and after 10 p.m. Weekends/Holidays before 7 a.m. and after 8 p.m.
SIGNATURE OF APPLICANT: _
DATE: ro / Za17
PRINTED NAME:
This Is the signature of: ❑ Owner or ❑ Owner's Representative
OCCUP. TYPE: CONST. TYPE: CODE:
BLDG SPRINKLED Yes / No
VALUATION: $
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Permit Fee: $ 3 0 ,
WAC Charge: $
Plan Review Fee: $
Sewer & Water Hook -Up: $
State Surcharge: $ D U
$
Sewer & Water DZ$:3-�
Site Inspection Fee: $
Wa. $
S.E.C. Fee: $
Muni SE $
Investigation Fee / Other Fee: $
*2016 SA: 2 485
Copy Charge ($.25 per 8.5 x11 page) $
$z0License
Check ($5) / Lead Check ($5) $
TOT$ ^N
SUB -TOTAL $ 3 9 . S7JNOTE:
Plumbing Fee (from Page 2) $
commercial plans will bo the Met Council Environments! Svcs
Fee from Pa e 2 $
for SAC determination. Escrow be required when permit is Issued. HvMechanical
after Met Council review no SAtried, escrow win be refun
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Special Conditions/Required Setbacks:
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Building Approval By:
DATE:
Printed Building Approval By.
❑ License Verification ❑ Lead Verification - Checked By.
City Approval By.
DATE:
Paid: $3,q, , Date: [v Receipt No. (L *53 By:
THIS CARD MUST BE VISIBLY POSTED, CITY`o-SPRINGRK
ACCESSIBLE, AND PROTECTED FROM
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WEATHER, AND PHYSICAL DAMAGE PERMIT CARD SPO21
FOR THE,DRATION OF THIS PERMIT
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(VAL D FOR A 1. SINGLE PROJECT)
Slte Address.- a�l a 1- `�fac Bullding:
Owner. Name.f�'1Q,+r�i-
Contractor Name. rV11� LOBS k
r 3�Jt
Contractor License R t�i 1`I Date issued. 4 (� a-0 I �'
- OFFICE USEREFER MENSCTLT
ROOFINGn SIDING [] WINDOW ;DOOR HANDOUT `
0; 4 Issued by
INSPECTOR DATE lf
Rec by eived;
:FENCE SHED Front J Back
r
;INSPECTION DATE Side: Side:
MECHANICAL ❑.FIREPLACE Q PLUMBING " , COMMENT '4
„.
ROUGH IN DATE = Pressure test for Dlumbins and hvdronic Dioina
_GAS LINE DATE Air test required for new aas line
FINAL - DATE as Gline fittins test'reouired
MUST:CALL TO SCHEDULE NO LATER THAN THE BUSINESS DAY PRIOR TO THE INSPECTION DAY "
Permit will expire 180 days after issuance All work.must compty with the NIN State Building Code
PHONE'(9521442=.7520 MNSPECT;'LLC r -z - TOLL FREE (888) 446 1801
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MINNESOTADEPARTMENT OF
LABOR & INDUSTRY
License/Certificate/Registration Detail
Class Type:
RESIDENTIAL BLDG CONTRACTOR
Number: BC631119
Application No:
233095
Status: ISSUED
Expire Date:
3131/2018
Effect Date: 4/1/2016
Orig Date:
6/17/2008
Print bate: 3/21/2016
Enforcement Action: NO
Name:
MINNESOTA LAKES REMODELING INC DBA MN LAKES
Address:
155 MCCULLEY RD
MAPLE PLAIN, MN 55359
Phone:
612-275-2767 Fax: Other.
Business Relationship Requirements
Name: SHERIDAN, PHILLIP J Lic/Reg No: QB139732
Status: ISSUED Application No: 267244
Expire Date: 3/31/2018 Effect Date: 4/1/2016
Orig Date: 6/17/2008
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