Permits - Permit# 948 - 2429 Black Lake Road - 1/1/1991C 11'Y OF SPITING PARK
BUILDING PERMIT APPLICATION
eI11LUllr(i jr4 ftlT APPI.I9ATi011 V-3 ULIIPMCIITB
milulrements
Lo bo handod in with Building Permit Applicatlom
Construction
Plans should
lucludur
I)
nulldlnq rarmlt Application - to be filled out R signed
Pormlt Application a Calculutlon filled out
vl
b)
rlrst [loot plan
rootingy s (eur►aatlon
plan
11
))
ne,;hanicnl
Energy Calculutionv - 'filled out
c)
Rlavetlons (of ell video)
41
Furlrlel, a Certifionto of Gurvey - if required
d)
Noll sections R cross
ssctlor,o
special connuctl(
51
rurolnll 7 oats of Construction Planar
of
Details - stairs oild
any
a) 1 sot for City to keep on file
b) l sot for builder to use on site
c) I set for the City of Spring Park
-
•N
ZONING DISTnICT
1" 111E ZONE
vn11. UnTL
I COND. USE DATE
LOI Alin -A 17
WIDT"II DEPTII
1,R011 JSI:D Sr•1LACKS
1-now R.SIDE
—HEAR Ls1DE
LAKE
ACCESS
NEW EXISTING
AGENCY-APPROV. DATE
CITY
COUN'rY
STATE J--
-PF%�ASEMr:Nr _
f1EMA(1K5: ( 'J�e7' (�
SITE ADDRESS
LEGAL DESCIIIPTION: PROP. ID.
LOT- BLOCK SUBDIVISION
En (Name)
(Phone)
i')AKY $ LYNI�-Li�ISIr' A15�1�1 S�gINT� PK�NIL�L�� r r c
ARCHITECT/ENGINEER - Musl Certify Mult{•Family, Commarclal 8r Ir►duttrial al co ComUuctlon 1'la116
r►�-ER.T.NO. _ __ — Acldrasel 11'I►Or►e)
(1=irn1)
BUILb)EFl (Fir1m IA�1dress) (Phone
ST 'M5 du 1L.DI kU.o t I�t 0100tr U N, G I1o485Gi 4• RD. 3 4, N DewooO MAI, 5 530
a
5TU055 j5VIL-DIN(1t HOus�nlovets— ►�oI.►U.f_ArK�, �—
TYPE or W011lc Now
. gw FouK f)P,-7-(0
CONST. TYPE I BLDO. SIZE
L. 501
Add{llon Remodel Renuvate
1
w. 20
IIESIDENTIAL STOTIIES B I
DWELL. DORMS/ri.n
_ UNITS 1 Z
GAIT. STALLS Planning[ Commission
n7T. APP. DA E
DET. 2
NON•RE510. PROPOSED list
-' OCC.
CLASS.
STORIES COUNCIL
APP. DATE
INSPECTION REQUIRED WORK REQUIRING
FOOTING bolero puur
SEPARATE PERMITS
_ Fr1AMING rough -In
INSULATION PLUMOING---
_ WALLBOARD Before Toping MECHANICAL
— ` F INA L before occupancy
WORK UEYOND Oil WITHOUT A nE-
GUIREU INSPECTION WILL OE SUD-
JECT To PENALTY,
INSPrc*lION 413.7357
1/I. 1101Jr Not_.iro. -
LOIIIIIG CEhTICICATION
SEWER �—
WATEn
GRADING ry FILLING --
r[G(:1'r11CAl Irorn Slau
Esr.CONS1. VALUATION
- 3033
-) Iz
HL Qrl 000
PERMIT TEES
BLDG. PERMIT 127, 00
STATE FEE / 010 0
PLAN REVIEW
Investigation
Fee
AVAIL. CNG.
SAC CHARGE
TOTAL DUE 5S
ACKNOVLEDGEMENI
TILE UNDERSIGNED NEREDy REQUESIS PERMISSION 10 MAK
IIIE REAL IMPROYEMENiS SPECIFIED, AND DECLARES ONO
PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPIANCE OF
All INFORMA110N, C04011IONS AND REQUIREMENIS REPR
PRESENIED ON 1111S DOCUMENI, 111E UNDERSIGNED FUR -
TITER AGREES 10 DO All WORKS IN STRICT COMPLIANCE
WITH ALL CITY ORDINANCES AND STATE OF MINNESOTA
BUILDING COUE yEQUIRINIS
Ilynaturo
I do hereby certify to the Orono Building Official tilat the following described work has been reviewed fur
compliance wit11 the Ioning Requirements of the City of SPRING PARK and will be approved for construction
upon approval of tho construction plans by the Building Official.
authorized slynature
iw!r.ulnO CooE rl,All 111:v_L1Y
(Bl,ildlny official lantnl
Approved be Approved with Corrections Not Approvedr Muat be novined
lzq4
j5ZA-
FORM B
SUPPLEMENTAL DATA
FOR BUILDING PERMIT
A. - GENERAL INFORMATION
Application Number
Tax Parcel Number
1. Applicants' Name (Last, First, M.1.)
&
2. Day Phone
C +5 _t1 ? (0
3. Evening Phone
4-71 -9 I S"S
4. General Contractor
5. Electrical Contractor`
6. Plumbing Contractor
Du.)Q a.
p
c � /fir, U�
UQ c K
7. Earthwork Contractor
8. Architecctt
LJ lXJ �
1. Type of Project
a. [ ] New Construction
b. [ ] Addition
c. [ ] Relocation
d. [ ] Repair
e.14 Foundation Only
f. [ ] Roofing
g. [ ] Other (specify)
2. Proposed Use
a. p4 Single Family
b. [ ] Multiple Family
c. [ ] Agricultural
d..[ ] Public
e. (] Commercial
f. (] Industrial
9. [ 1 Other:(specify)
B. PROJECT INFORMATION
3. Lot Dimensional Data
Proposed Requlred
a. Area in ft�
or acres:
b. Lot width at
building line: _
c. Lot depth:
d. Lake/Stream
setback: _
e. Road setback:
4. Water Level Data
• Calculation of Regulatory Flood
In: k"ea Level Datum
Protection Elevation (RFPE) •
[ I Assumed Datum
d. Base Flood (1 fb-yr.) 21.
a. Highest known
level
Elevation:
e. Freeboard /req'd
water : =cri -
b. Highest known ground
_
by ordinance:=_e�
water level: _
L Floodway Stage
c. Ordinary high
Increase:
water level: = 2-,or
g. RFPE : =10
(add d.,e. and L)
f. Side lot 5. Structure Type
setback: = btResidence [ ] Ag. Bldg.
g. Minimum access [ ] Garage (] Storage
elevation: _ [ ] Office [ ] Boathouse
[ ] Warehouse [ j Deck
[ ]Other (specify below)
C. STRUCTURE DATA
6. Sewage Disposal 7. Water Supply
Public Public
[ ] Drainfield [ ] Private Well
[ ] Holding Tank
( ] Alt System
1. Structure Elevation Requirements
2. Structure Dimensions
3. Type of Construction
5• Project Cost Factors
In: [ ] N.G.V.D.
I
r
so
]¢Wood/Frame
00
a. Cost of Improvements: $ 2�D. ( 0
Assumed D
[ ] Datum
a. Len ft.)
� ( --
10
p];Masonry
b. Estimated Value of
Existing Structure: $ Sbo
[ ] In relation to street
b. Width (ft.) =
"L."
[] Metal
c. Percentage Cost of
proposed required
w 1'1 x $ �
_
[ ] Pole Bldg.
[ ] On -site Prefab
Improvements: 4-0%
divided by b. X
a. Basement or
Floor): _9 A 9 n
Areas In ft- z
c. Basement = 113(-OF
[ ] Off -site Prefab
(a. 100 percent)
4. Heating
6. Summary of Supporting Documents
(lowest -00 -
b. First Floor
d 1„ Floor = 1
[ 13(OF
(above grade):
c. Max. Building
"d
e. 2 Floor
[I Oil
[ ] Sketch Plan (FORM H) [ ] Lot Profile
Height: _
-L
f. Total Area = Z(a F
Gas
[ ] Elevation View [ ] Lighting Plan
d. Fill Elev. Adjacent
[ 1 Electric
Plan View Plumbing
*I [ 1 9
to Structure: _
[ ] Wood
[ ] Topo Survey mot Survey
[ ] Solar
-KOther (specify below):
B.DC 44 D ETA 1 L
I hereby certify with my signature that all data on my application forms,
—
plans and specifications are true and correct to the best of my knowledge:
Signature o
p scant Date
U
BUILDING PERMIT
[ ] APPLICATION IS HEREBY DENIED
[ ] PERMISSION IS HEREBY GRANTED TO ;
all in accordance with the application, addendum form, plans, specifications and all other supporting date, unless specified
hereinafter In the GENERAL and/or SPECIAL PROVISIONS.
ZY ORDER OF:
Signature of Permitting Authority Title Date
NOTE: THIS PERMIT TERMINATES ON: except as provided for by local ordinance and/or Minnesota Law.
- SEE REVERSE FOR GENERAL AND SPECIAL PROVISIONS -
MDNR-MAY,1987
PAGE 2
FORM B - BUILDING PERMIT
GENERAL PROVISIONS
1. This permit [ ] is; [ ]is not subject to the State Building Code.
2. No changes in plans or specifications can be made to the work authorized herein unless such change is first
approved in writing by the permitting authority.
3. Permittee shall grant access to the site at all reasonable times so that the permitting authority or his/her
agents may conduct inspections to ascertain compliance with the terms and conditions of this' permit.
4. The construction site shall be kept reasonably free of debris at all times so as to not create a public nuisance.
5. Permittee shall install permanent and temporary erosion control measures in order to prevent erosion of
disturbed soils from the project site onto adjacent parcels of land, public waters, public roads, ditches, sewer
facilities and the like. Permittea shall cease all related authorized construction activities until such time as
any such problem is corrected as agreed to by the permitting authority.
6. No certificate of occupancy or zoning compliance may be issued until all the provisions and conditions of
this permit are complied with in full.
7. A copy of this permit or an official notice or placard thereof must be posted in a conspicuous place
protected from the effects of weather, no more than 12 feet above grade on the premises which the work is to
be done and shall be maintained there until completion of said work.
8. The granting of this permit does not exempt the permttee from having to secure other permits from other
state, federal or local units of government which may have jurisdiction over portions of the authorized
project.
SPECIAL PROVISIONS
2.
3.
4.
5.
6.
7.
8.
)rm tro. zoa—(Kev. s-io-eu) Valuation $2D,OOO.OD minenuav,s uo., minneapi
® in BBttid?g. Per21077p.00p00p
$...P1aneReview 134:55 J......
�0 ........ ..............
351.55
Otate of Minnesota,.........CITY...............of...... SPRING PARK..................
County of .......... HENNEP.IN............................................
Office of ....... BUI.LDING INSPECTOR
'-r Mit
g
IN CONSIDERATION OF The statements and representations made by...........................................................................
---------------------------•-•-•--...----------.----....------................---------••----GarY...&...!LY.nn...Ghri.s en en............---._.....---...-•----..................-•-----•----........---•----...---------...------...........----.........-•--------•
in their application therefor duly filed in this office, which application is hereby made a part hereof, PERMISSION IS HEREBY
GRANTED To said....... Gary & Lynn Christensen _ .............................................................................
to
New Foundation_.................................................................a building described as follows: kind of construction
...............................................................•----•-....
(build, erect, install, add to, alter, repair, move, wreck, as the case may be)
frontor 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..19.-1.17.-23_-12.-001.8._-__
2429 Black Lake Road -- - ..... _.................
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 ............. City .................................................. of ........ Spring _Pdrk ;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 following
......--
..... .ne.---- f........ e..............o............................._._.........._..............................................................--........ .......................
(Electrical work, plumbing, heating, plastering, etc., if such there be.)
for which special permits must be secured.
Given under the hand of the-Bu....di.ng Inspector .............................of said ....... City ............................................... and its corporate seal and
attested by its .Clerk this.
__.11 th.-- ...._................. day of....... Une... 19 9.1
Attest:
..................... ...... ...........
Clerk
........................................:.... l... ..................----........... ....
/uildin InsI.ector .
................. -......... ...... _..... ..........................