Permits - Permit# SP14-032 - 2486 Black Lake Road - 1/1/2014CITY OF SPRING PARK
Noise Ordinance In Effect:
4349 Warren Avenue Spring Park, MN 55384
Phone (952) 471-9051 Fax (952) 471-9160
Monday - Friday before 7 a.m.
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and after 10 p.m.
Weekends/Holidays before 7
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BUILDING PERMIT
a.m. and after 8 p.m.
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DATE 'Utz
CHANGES TO APPROVED BUILDING PLANS MUST HAVE CITY APPROVAL
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SITE ADDRESS 74 U(O -1�,LAC-y �'�� (�D PID
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CONTACT NAME - PHONE - EMAIL - FAX
ARCHITECT (if ReguirecIl Name / Address IF Ity Stale Zlo Phone
CONTRACTOR Name/Address 21hone
J�-W\)b-Dom —[?,L)i 0�►�l �a sr S�
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CONTACT NAME - PHONE - EMAIL - FAX ( (, �u v L_A N J7 1 L - Z 1 Z - 49 C
CONTRACTOR LICENSE # G 3 Ii 2
- TYPE OF WORK _ -
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❑ New Home
❑ Deck
a -Roof
❑ Addition
❑ Fence Hei ht:
❑ Re -Side
❑ Commercial Residential
EST. VALUA ION OF WORK
❑ Remodel
❑ Pool
❑ Rat. Wall Height:
$ Q _._ --- - -
❑ Finish Basement
❑ Stucco Demo
❑ Window Replacement
Building Height: Feet
❑ AccessoryStructure
❑ Stucco
❑ Other.
# of Stories:
SCOPE OF WORK:
of r - tLo _
Use of Building:
Signature of this epvocirdon by he repel property owner or a licensed contractor, as the owners representom Is re0utred and authorizes the city zoning ndRununator or designee and the City Building Official or designee
bD ender 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 as Wonnation Is he and Correct to the bell of my
knowledge. I fuller agree that all work pmlormed will be In accordance with approver) plans. spearicatim and cwd b= and to abide by al erdklerrm of the City and the laws of the State of Minnesota regarding actions
ken pursuaM to this permIL I agree to pay all plan review fees oven It I choose not to proceed with the wmk Permit e>mbes when work b not wmmemzd with 180 days from dale of permit Issued. or it building and
work b suspended. abandoned or no Inspected for Clio days. work beyond orwithout a pens orins Fit wit be subject to a penalty.
Call MNSPECT for �Insis (9 442-7520. (24 Hour Notice) 8:00 a.m. - 4:30 p.m.
SIGNATURE OF APPLICANT: DATE:
PRINTED NAME: Svl v L�
DATE:
- ---- ---QFFX E+UJLVNE_."Z r, I =i-
LEGAL DESCRIPTION: Lot Block Addition Zoning
Valuation of Permit: $ Lot Area:
OCCUP. TYPE: CONST. TYPE: CODE: BLDG SPRINKLED Yes / No
SETBACKS: REQUIRED M -
-
ACTUAL (ft)
-
per�y,jt F�:g
- Front (ROB
--
'NOTE: Commercial plans will
Plan Check Fee:$
--- -
Rear
be submited to the Met
Council Environmental Svcs
-- State Surcharge_$ S• o 00
Site Insp. Fee:$
Side
- —
—_-__ .. _
-- _ Side
for SAC (sewer availability
_
Muni SEIWA Fee:$
Comer
charge) determination.
_
S.E.0 Fee:$
_ Lakeshore
_ - _ - - -
Escrow payment will be
'2013 SAC Escrow :$2,435
Wetland
required when permit is
WAC Charge:$
Other
— issued.
If after Met Council
review no SAC is determined,
Sewer A H2O tfook.Up.$
sewer s ►+zo onean,ea $
—_ - -� j-- —_ — --
escrow will be refunded in full.
----
Water Meter.$
Paid - Receipt No.
Other$
TOTAL DUE:
_
Date By
s _VS-od
BUILDING APPROVAL BY: DATE.
- — -- - - - TIME.
C/TYAPPROVAL BY: ;DATE:
- .. . _. -- ---- .. _ TIME.
All new con_struction 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.
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THIS CARD MUST BE VISIBLY POSTED, CITY Of SPRING PARK Permit
ACCESSIBLE, AND PROTECTED FROM
PERMIT CARD
WEATHER AND PHYSICAL DAMAGE S P 14-03
FOR THE DURATION OF THIS PERMIT.
(VALID FOR A SINGLE PROJECT)
NATURE of WORK:
Site Address: 446 z� J4,&, WoL Building:
Applicant Name: Date Issued:
INSPECTION RECORD
REFER TO HANDOUT FOR INSPECTION REQUIREMENTS
OFFICE USE
ROOFING
0 SIDING Q WINDOW CD DOOR
HANDOUT
INSPECTOR:
DATE:
Issued by: 'Received by:
FENCE' M SHED
Front: Back:
INSPECTION:
DATE:
Side: Side:
MECHANICAL
FIREPLACE a PLUMBING
COMMENT
ROUGH -IN:
DATE:
Pressure test plumbing and hydronic piping
GAS LINE:
DATE:
Air test required for new gas line
FINAL:
DATE:
Gas line fitting test required
MUST CALL TO SCHEDULE NO LATER THAN THE BUSINESS DAY PRIOR TO THE INSPECTION DAY
Permit will expire 180 days after Issuance. All work must comply with the MN State Building Code.
PHONE (952-442-7520 MNSPECT, LLC TOLL FREE (888) 446-1801
' MINNFySdTADEPARTMENTOF
LABOR & INDUSTRY
I
RESIDENTIAL BLDG CONTRACTOR
Construction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road N St. Paul, MN 55155
Website: www.dll.mn.00v/ccld.aso Email: dli.license0state.mmus Phone: 651.284.5034
This is to certify that the certificate holder is licensed as a RESIDENTIAL BUILDING CONTRACTOR in the state of Minnesota and is in
compliance with Minnesota Statutes 326B.805, and may build residential real estate, contract or offer to contract with an owner to build
residential real estate, and contract or offer to contract with an owner to improve existing residential real estate; provided the
responsible individual is at all times a QUALIFYING BUILDER and the certificate holder maintains compliance with the required general
liability insurance, and workers' compensation laws.
License : RESIDENTIAL BLDG CONTRACTOR
Lic Number : BC234129 JUVLAND HOMECAAE INC
Effective Date : 04/01/2014 9099 30TH ST SW
Expiration Date : 03/31/2016 HOWARD LAKE, MN 55349
VERIFY UP-TO-DATE STATUS, BOND, AND INSURANCE INFO AT www.dii.mn.gov/ccld/LicVerify.asp (ENTER NUMBER).
Minnesota Department of Labor and Industry
Construction Codes and Licensing Division
443 Lafayette Road N
Saint Paul, MN 55155
NOTICES
NOT TRANSFERABLE
CHANGE YOUR BUSINESS STRUCTURE
SUBMIT A NEW APPLICATION FOR NEW ENTITY
RENEW OR REPLACE INSURANCE POLICY
SUBMIT NEW CERTIFICATE OF INSURANCE
Licensing and Certification Services
Phone: 651.284.5034
Email: DLI.License@state.mn.us
Website: www.dii.mn.gov/ccid.asp
JUVLAND HOMECARE INC
9099 30TH ST SW
HOWARD LAKE, MN 55349
NOTIFY THE DEPARTMENT OF A CHANGE IN YOUR BUSINESS.
Failure to do so, subjects you to administrative penalties of up to $10,006.
15-Day Notice Requirement —Forms available online at www.dli.mn.gov/CCLD/LicUpdate.asp _
• Change in business' physical address, mailing address, phone number, or email address
• Change in control, owners, officers, directors, members, partners
• Change in business' legal name and/or assumed name
• Loss of or change in QUALIFYING BUILDER
• Change in general liability insurance or workers' compensation insurance coverage
Immediate Notice Requirement— Notification to DLI in writing
• Judgment Debtor. A` licensed contractor has 15 days to provide written notice of the finding that it is found to be a judgment
debtor based upon conduct requiring licensure.
• Bankruotcv Petition Filed. A licensed contractor has 15 days to provide written notice that it filed a petition for bankruptcy.
• Conviction Notice. A licensed contractor has 10 days to provide written notice that it has been found guilty of a felony, gross
misdemeanor, misdemeanor or any comparable offense related to the license, including convictions of fraud,
misrepresentation, misuse of funds, theft, criminal sexual conduct, assault, burglary, conversion of funds, or theft of proceeds
in this or any other state or any other United States jurisdiction.
YOUR CERTIFICATE IS BELOW THE PERFORATION. SHOW CERTIFICATE WHEN OBTAINING PERMITS.
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