Permits - Permit# 04-19 - 2436 Black Lake Road - 1/1/2004CITY OF SPRING PARK
4349 WARREN AVENUE
SPRING PARK, MN 55384
952-471-9051 FAX 952-471-9160
BUILDING PERMIT APPLICATION
Building Permit Application Requirements:
1. Application to be filled out & signed
2. Mechanical Permit Application & Calculation filled out
3. Energy Calculations filled out
4. Furnish a Certificate of Survey - See Attached
5. Furnish 3 sets of Construction Plans
a)1 set for City files
b) 1 set for builder to use on site
c) 1 set for City Building Inspector
Construction Plans should include:
1. First floor plan
2. Footing & foundation plan
3. Elevations of all sides
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) // OWNER OR l
JOB SITE ADDRESS Z4 � b 9 L ptdc-
Date Received ! �7 a9
Date Approved 6/7 0 5r
Permit No.
Fees To Be Charged:
Permit
State Surcharge /• SO
Plan Review
SAC Charge
Availability Chrg
TOTAL S-el, %Sr
/ - ii 7 - ,-)- 5 -/a -Go;
NAME OF OWNER N6 ! L -/SC- ' Q f I" & & " HOME PHONE q 7 t - f 5�WORK PHONE
MAILING ADDRESS S i�-!vr l3 /v ) CITY ZIP
CONTRACTORr V �// F_p S n¢ PHONE MOBILE MOBILE PHONE ��7 3 )/
MAILING ADDRESS �o SA Sa S-Ay,-,.06 l� % ®1� CITY I /`" Ir/��'/L i / ZIP 5-5?2--
STATE LICENSE NO. �� d
ARCHITECTIENGINEER PHONE
MAILING ADDRESS
CITY
NAME REGISTRATION NO.
ZIP
TYPE OF WORK: NEW ADDITION ACCESSORY STRUCTURE MOVE DEMO
REMODEUALTERATION>� RENOVATE _ LAND ALTERATION ^
PROPOSED WORK (Describe In Detail)
ZONING DISTRICT
STORIES SQ. FEET OR EACH FLOOR NO. OF BEDROOMS GARAGE STALLS
ATTACHED OR DETACHED BLDG. SIZE: LENGTH WIDTH HEIGHT
ESTIMATED CONSTRUCTION VALUATION (excluding land) $ 2% -3 1 0 6 U
BUILDING PERMIT APPLICATION
PAGE 2
HARDCOVER CALCULATION WORKSHEET
A. House X = S.F.
Length Ndth
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.
1 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 State 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 ppproved plan.
APPLICANT'S SIGNATURE DATE 6-1 - O ! -
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 952-249-4600
ZONING CERTIFICATE
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 construction upon
approval of the construction plans by the Building Official.
Name Date
BUILDING CODE PLAN REVIEW
Name Date
Fnrm Nn_ 2Xq
Election Systems and Software 1-800-800-8225
ND.04-19 ..........
#tstr of filinnesots, ....Ci.tY .... of. .Sgring Park...........
BuriectoCounty of .... Hennegi n ............ Office of ..........i ng In ....... .
IN CONSIDERATION OF The statements and representations made by ......................
W. F. Smith Roofiin
...............................9....................................................................
in application therefor duly filed in this office, which application is hereby made a part hereof, PERMISSION IS HEREBY
GRANTED To said ...... w•..F.. ,Srtli.th .RQo.fi.r1g................................................... as owner
to ... T r off & re -.roof. ho.lse..aer. appl.ic.ation. . .. . . . ... . .....a building described as follows: kind of construction
(build, erect, install, add to, alter, repair, move, wreck, as the case may be)
.....................................................................................................
front or 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 ................
2436 Black Lake Road ... 19-117-23-12;0012.....................
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 ...... C i, ty........... of .. Spr i j'g. Park....... ;
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: ... Non.e . of. the. fol l o4ii ng
........
(Electrical work, plumbing, heating, plastering, etc., if such there be.)
for which special permits must be secured.
Given under the hand of the .........Building..........Inspector.. of said ...... City ...............and its corporate seal and
7thJune
attested by its ..... Clerk ................ this ....................... day of ................... Year.. ?004.. .
Attest:
......... William.D...Weeks.............. W e. Oman .................................
.
r
Clerk B:lildirr Inspector.