Permits - Permit# 10-31-90 - 2436 Black Lake Road - 1/1/1990CITY OF SPRING PARK
BUILDING PERMIT APPLICATION
e1tILUING PERMIT APPI.ICATION I:SQUIREMENTS
Requirements to be handed in with Building Permit Applicationt
Construction Plans should ittcludot
1)
Building Permit Application - to be filled out F signed
a►
first floor plan
2)
Merhanical Permit Application i Calculation filled out
b)
rooting i foundation plan
It
Energy Calculstiona - 'filled out
e)
Islevations (of all aides)
4)
rurnish a Certificate of survey - if required
d)
Nall sections i cross sections
51
Furnish D sets of Construction Planst
e)
Details - stairs and any special connectic
a) I set for City to keep on file
b) 1 set for builder to use on site
c) 1 set for the City of Spring Park
IS
ZONING DISTRICT
f f IRE ZONE
VAR. DATE
CONO. USE DATE
LOT AREA
WIDTH DEPTH
PROPOSEDSEIBACKS
FRONT R.SIDE
REAR L.SIDE
LAKE
ACCESS
NEW EXISTING
AGENCY-APPROV. DATE
CITY
COUNTY
STATE
PR. EASEMf_NT
REMARKS
SITE ADDRESS 1 41
LEGAL DESCRIPTION: PROP. ID. _1_q_//7__ / oo/
LOT_ BLOCK SUBDIVISION
W R /
(, amel
�e
(Address) y,/IP oneJ,
7
,� c o
a, r✓ _ .
ARCHITECT/ENGINEER - Must Certify Multi -Family, Commercial fit Industrla Construction lens
"
ERT.NO. — Addressl% (Phone)
(Firm)
BUILDER
(FirmI
IA dress) (Phone)
A., yj & v-
J-0 11Aq Cxy\.s
t to cT0
TYPE OF WORK Now Addition
Remodel Renovate
00
am
C NST. TYPE
BLDG. SIZE
EST. CONST. VALUATION
bi(ox IrJ.4o Pam- �. �=
W. O`O'C
lit.
neSIDEN IA
STORIES 0 1 7
BDRMS/FLR
s
PERMIT FEES
BLDG. PERMIT 9 0 .00
STATE FEE 5'0
DWELL.
UNITS
PLAN REVIEW S8•SO
GAR. STALLS
Planninl� Commission
ATT.
APP, DA E
PENALTY
DET.-ate
DOCK
AVAIL. CHG.
NON•RESID.
PROPOSED USE
SAC CHARGE _
OCC.
CLASS.
STORIES
COUNCIL
TOTAL DUE /c5 Z -D0
APP. DATE
INSPECTION REQUIRED
V-- FOOTING before pour
_• FRAMING rough•In
_IX INSULATION
WALLBOARD Before Taping
J__ F INA L before occurancy
WORK BEYOND OR WITHOUT A RE•
GUIRED INSPECTION WILL BE SUB-
JECT TO PENALTY.
INSPECTION 473.7357
24. (flour. Nofice.
ZONING CEhTIrICATION
WORK REQUIRING
SEPARATE PERMITS
PLUMBING —
MECHANICAL W(00& Oit--
SEWER
WATER
GRADING ✓i, FILLING
ELECTRICAL from Ststs
ACKNOWLEDGEMENT
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAK
THE REAL IMPROVEMENTS SPECIFIED, AND DECLARES UND
PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPTANCE OF
ALL INFORMATION, CONDITIONS AND REQUIREMENTS REPR
PRESENTED ON THIS DOCUMENT. THE UNDERSIGNED FUR-
THER AGREES TO DO ALL WORKS IN STRICT COMPLIANCE
WITH ALL CITY ORDINANCES AND STATE OF MINNESOTA
BUILDING CODE REQUIREMENTS.
signature 4 Date��-o - 90
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 construct,lon
olion approval.of the construction plans by the Building Official.
authorized signature date
nya,DINO CODE PLAN REVIEJ
u Iding official (dntol
Approved _X_Approvod with Corrections Not Approvedr Must be Revised
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 L ! v\
3. Evening Phone
4. eneral Contractor n
S. Electrical Contractor
6. Plumbing Contractor
b!d
Eork Contractor
761T,50f) -
8. Architect
cau oun�
1. Type of Project
a.)&w Construction
b. [ J Addition
c. (] Relocation
d. [ J Repair
e. (J Foundation Only
I. [ ] Roofing
9• I I Other (specify)
2. Proposed Use
a. (j Single Family
b. [ ] Multiple Family
c. [ ] Agricultural
d. [ ] Public
e. [ ] Commercial
I. [ ] Industrial
9• I 1 Other:(specify)
9, Ca �r acL: ,.
3. Lot Dimensional Data
a. Area In ft.2
or acres:
b. Lot width at
building line:
c. Lot depth:
d. Lake/Stream
setback:
e. Road setback:
f. Side lot
setback:
g. Minimum access
elevation:
B. PROJECT INFORMATION
Propoced Roqulnd
4. Water Level Data
In: [ ] Sea Level Datum
(] Assumed Datum
a. Highest known
water level:
b. Highest known ground
water level:
c. Ordinary high
water level: —
_
5. Structure Type
[ ] Residence [ ] Ag. Bldg.
�t,Q[ ] Storage
_
j`Garage
Office [ ] Boathouse
[ ] Warehouse [ ] Deck
[ ] Other (specify below)
C_ STRiim mp DATA
• Calculation of Reaulatory Flood
Protection Elevation IRFPEI
d. Base Flood (100-yr.)
Elevation: _
e. Freeboard /req'd
by ordinance: _
f. Floodway Stage
Increase: _
g. RFPE : _
(add d.,e. and f.)
6. Sewage Disposal
7. Water Supply
Public
Public
ralnfleld
] 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.
1
ood Frame
a. Cost of Improvements: $
(] Assumed Datum
s. Length (n) _�
_[fWasonry
b. Estimated Value of
Existing Structure: $
(] In relation to street
b. Width (fL) _
(] Metal
c. Percentage Cost of
proposed required
Areas In fL1
[ ] Pole Bldg.
(] On -site Prefab
Improvements : %
(a. divided by b. X 100 percent)
a. Basement or
[ 1 OH -site Prefab
(lowest Floor): =
c. Basement =
b. First Floor
d. 1sr Floor =
4. Heating
6. Summary of Supporting Documents
(above grade): —
c. Max. Building
nd
e.2 Floor =
I ] Oil
(] Sketch Plan (FORM H) [ ] Lot Profile
Height: =
[ ] Gas
(]Elevation View (]Lighting Plan
d. Fill Elev. Adjacent
f. Total Area _
[ Electric
[ ] Plan View (] Plumbing
to Structure:
AWood
[ ] Topo Survey . (] Lot Survey
]Solar
[ ] Other (specify below):
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 of Applicant Date
BUILDING PERMIT
[ J 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.
tY 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
PAGE2
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. Permittee 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 permittee 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
6.
7.
8.