Permits - Permit# 11-31B - 2486 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
a.m. and after 8 p.m.
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CHANGES TO APPROVED BUILDING PLANS MUST HAVE CITY APPROVAL
SITE ADDRESS of PID
OWNER Na A
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CO TACT E-PHONE-EMAIL-FAX r
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Nagle I Address I City j State 17in 1 Phnn&
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CONTACT NAME - PHONE - EMAIL - FAX /
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CONTRACTOR LICENSES
TYPE OF WORK
❑ New Home
❑ Deck
❑ Re -Roof
_ _
❑ Commercial esidential
❑ Addition
❑ Fence Height:
❑ Re -Side
EST. VALUATION OF WORK
❑ Remodel
❑ Pool
❑ Ret. Wall Height:
$ 'UO❑
Finish Basement
❑ Stucco Demo
• Window Replacement
Building Height: Feet
❑ Accessory Structure
❑ Stucco
❑ Other:
# of Stories:
SCOPE OF WORK:
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Use of Building:
Signature or this applicabon by the legal prop" owner or a licensed contractor. as the owner's representative Is required and authorizes the City Zoning Administrator or designee and the City Building MCI= designee
to enter upon the property to perform needed inspect ions. Entry may be without prior notice. I hereby acxnowledge that I have read this application and stale 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 ablde by all ordinances of the City and the laws of the Slate of wrinesota regarding actims
pursuant to this permit I agree to pay all plan revlewfees even 11 I choose not to proceed with the work. Permit expires when work Is not commenced with 180 days from dare of permd issued, or if building and
work Is suspended, abandoned or not Inspected for 180 days Work beyond or Ahoul a perntll or inspection wil be subject to a penally.
Call MNSPECT fo a (o at (8 2) 442-7520. (24 Hour Notice) 8:00 a.m. - 4:30 p.m.
SIGNATURE OF APPLICANT: ` DATE ' _
PRINTED NAME: yr DATE: /
ICE
-Block
LEGAL DESCRIPTION: Lot Addition Zoning
Valuation of Permit: $
I Lot Area:
OCCUP. TYPE: CONST. TYPE: CODE: BLDG SPRINKLED
Yes I No
SETBACKS' REQUIRED (ft)_
_Front (ROW)
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 Mel Council
review no SAC is determined,
escrow will be refunded in full.
Permit Fee:$
Plan Check Fee:$
State Surcharge:$ _
Rear
Side
Side
Site Insp. Fee:$
_T
_
Muni SE/WA Fee:$ _- ---------
S.E.0 Fee:$
Comer
Lakeshore
—_� _ _
•tot 1 SAC Escrow :$2,230
Wetland
Other
WAC Charge:$
sewer a HM Hook-up,$
Sewer 8 M20 Disconnect•.$ -- — — -
- '- --
—' Water Meier:$
Receipt No.
Other:$
Date
I B
TOTAL DUE:
S
BUILDING APPROVAL BY-:
-
I DATE:
TIME:
—'
CITYAPPROVAL BY.:
DATE.
TIME:
Alin construction and/or dwelling expansion shall require 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.