Permits - Permit# 11-17B - 2433 Black Lake Road - 1/1/2011CITY OF SPRING PARK
4349 Warren Avenue Spring Park, MN 55384
Phone (952) 471-9051 Fax (952) 471-9160
BUILDING PERMIT
Noise Ordinance In Effect:
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Monday - Friday before 7 a.m.
and after 10 p.m.
Weekends/Holidays before 7
Rm. and after 8 p.m.
DATE — _
CHANGES TO APPROVED BUILDING PLANS MUST HAVE CITY APPROVAL
SITE ADDRESS CGK )<&— PID
OWNER/Address/ City/ State /Zip
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CONTACT NAME - PHONE - EMAIL - FAX — z� ?/ —
ARCHITECT
CONTRACTOR
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CONTACT NAME - PHONE - EMAIL - FAX
CONTRACTOR LICENSE #
TYPE OF WORK
❑ New Home
❑ Deck
O�Re-Roof
❑ Commercial ❑ Residential
❑ Addition
❑ Fence Height:
❑ Re -Side
EST. VALUATION OF WORK
❑ Remodel
❑ Pool
❑ Ret. Wall Height:
$
❑ Finish Basement
❑ Stucco Demo
❑ Window Replacement
Building Height: y G Feet
❑ Accessory Structure
❑ Stucco
❑ Other:
# of Stories: _
SCOPE OF WORK:
Use of Building:
Signature of this application by the legal property owner or a licensed contractor, as the owners representative is required and authorizes the City Zoning Administrator or designee and the City 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 correct to the best of my
knowledge. I further agree that all work performed will be in accordance with approved plans, specifications and conditions and to abide by all ordinances of the City and the laws of the State of Minnesota regarding actions
taken pursuant to this permit I agree to pay all plan review fees even If 1 choose not to proceed with the work. Permit expires when work is not commenced with 180 days from date of permit issued, or if building and
work is suspended, abandoned or not inspected for 180 days. Work beyond or without a permit or inspection will be subject to a penalty.
Call MNSPECT for inspections at (952) 442- 20. ur Notice :00 a.m. - 4:30 p.m.
SIGNATURE OF APPLICANT:
DATE: —
PRINTED NAME:
DATE:
--------------------------- OFFICE USE ONLY BaOW THIS LfiVE ---------------------------
LEGAL DESCRIPTION: Lot Block Addition Zoning
Valuation of Permit: $ I
Lot Area:
OCCUP. TYPE: CONST. TYPE: CODE: BLDG SPRINKLED
Yes / No
SETBACKS: REQUIRED (ft)
ACTUAL (ft)
'NOTE: Commercial plans will
be submited to the Met
Council Environmental Svcs
for SAC (sewer availability
charge) determination.
Escrow payment will be
required when permit is
issued. If after Met Council
review no SAC is determined,
escrow will be refunded in full.
Permit Fee:$
Front (ROW)
Plan Check Fee:$
State Surcharge:$
Rear
Side
Site Insp. Fee:$
Side
Muni SE/WA Fee:$
Corner _
S.E.0 Fee:$
Lakeshore
•2011 SAC_Escrow:$2,230
Wetland
_
M WAC Charge:$
Other
Sewer & H2O Hook-up:$
sewer a H2o oiecomme x:$
Water Meter:$
Paid
Receipt No.
Other:$
Date
BUILDING APPROVAL BY:
By
TOTAL DUE:
$
DATE:
TIME:
CITYAPPROVAL BY:
DATE:
TIME:
All new construction and/or dwelling expansio
equire a certified survey dated within five years of application.
All new construction and/or dwelling expansion will be subject to contracted planner review and may add to the review time.