Permits - Permit# 17-18 - 2494 Black Lake Road - 1/1/2017 (3)CITY OF SPRING PARK
PAGE 1 BUILDING PERMIT
4349 Warren Avenue
Handout Given
Spring Park, IVIN 55384
Phone: 952-471-9051 Fax: 952-471-9160
(Handout
Given
SITE ADDRESS:
PID: I 0H r� -23- af-001
1) Was the home constructed before 1978? (YES o, continue with line 2, NO o continue without completing EPA Section)
2) Will the work disturb 26 0 ft of interior painted surfaces or 2:20 sq ft of exterior painted surfaces? (YES o go to line 4, NO o line 3)
3) Are there any windows being replaced? (YES o, go to line 4, NO
0' continue without completing EPA Section)
4) Has this home been Certified Lead Free? (.YES o, you MUST Attach Certification Information, NO a complete line, 5)
6) EPA Contractor Certification Number. NAT -
(applies to contractor only)
PROPERTY OWNER: Tim, Ejkk-
ddress:
CRY, State, Zip:
Email:
Contact Name:
Phone:
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CONTRACTOR: :5'6WV—.00 L4'L
Address: I C-1 (, A-ILS ST
City, (,,jA- I-LAT - PC State: )6-. N-), Zip:
Phone: C17_-7,f/-0ijj3 Fax:
Contractor License No:
Contact Name: --,-7< Phone: It 25111 7/4
Email: Al A--MQ S-M tN +e too
ARCHITECT: lat, fl�
Address:
City: LovA—h—LAlf-W State: Zip:
Phone: Fax:
•
Email:
Contact Name: Phone:
TYPE OF WORK: o New Construction
o Dock o Re -Roof
ci Commercial ri Residential c3 Change of Use
n Pool o Re -Side
EST. VALUATION OF WORK o Finish Basement
r3 Retaining Wall o Fence
$ o Remodel
o Porch p Shed
Square feet c Addition
00ernolition o Window/Door Replacement
JoGarage-Attached/Detach
o Plumbing -provide detail on Page 2 # being replaced
Detailed Description of Work: o Accessory Structure
o Mechanical -provide detail on Page 2 c Misc Other
DiFr-,a &LD
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1paturs of this application by the legal property owner or a Doensed contractor, as the owners representative, Is required and authorizes the Zoning Administrator or designee and the Building Ofmcial
designee to enter upon the property to perform needed inspections. Entry may be without prior notice. I hereby acknowledge that I have mad this application and state that am Information is true and
correct to the best at my knowiedge. I further agree that am work performed will be in accordance with approved plans, speciricatians and conditions and to abide by an ordinances of the Municipality
the laws of the State of Minnesota regarding actions taken pursuant to this permit.. lagree to
pay all plan review leas even If I choose not to proceed with the work- Permit wpires when work
.4
. is not commenced within 180 days from date of peardt, or If work Is suspended, abandoned, or not Inspected Ior iso days. Work beyond the scope of this pandit or work without a permit or Inspection.
•
be subject to a penalty.
Noise Ordinance In Effect MONDAY.= FRIDAY Befoo.m. and after 10 p.m. Weekends/Holidays I before 7 am. and after 8 p.m.
SIGNATURE OF APPLICANT:
DATE: :C. I
PRINTED NAME: M."", grv% tw_
--k
This Is the signature of: o Owner or )p Owners Representative
OCCUP. TYPE: 777 cONST. TYPE: J3 CODE:
9,,Ok'j —TVC_ BLDG SPRINKLED Yes ?6o��
VALUATION: $ V)'6so -Q-0
Permit Fee: $ 2I -50
WAC Charge: $
Plan Review Fee: $ 101-1-9Z
Sewer & Water Ho.ok-Up: $
State Surcharge: $ S 3 3
Sewer & Water Disconnect: $
Site Inspection Fee: $
Water Meter $
S.E.C. Fee: $
Muni SENVA Fee: $
Investigation Fee / Other Fee: $
*2016 SAC Escrow: 2
Copy Charge ($.25 per 8..5,x1I page) $
Other. $$
z
License Check ($5) / Lead Check ($5) $ .0-0
TOTAL DUE:
0
W
SUB -TOTAL $ 3OL� -
In
Plumbing Fee from Page 2) $
NOTE: Commercial plans will be submitted It the Met Council EnvI ntal Svcs
t I
Zft WILSsu.S711f
Lu
Mechanical Fee from Page 2) $
for SAC determination. Escrow payment wIIIjZu1rM&dIts
after Met Council review no SAC Is determined, escrow will be refunded In full.
2
LL
ILL
Special Conditions/Required Setbacks:
0
Building Approval By.
DATE:
Printed Building Approval By:
1K License Verification 0 Lead Verification -Checked By:
[City Approval By,
DATE:
IPaid:qj
qqj,r)l Date: 57//T Receipt No.
IW?q By:
3E
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Office Use Only
Plan Review Comment Sheet
#R17-212
Municipality: Spring Park Permit #: I7 % NAT #:
Applicant: Jim Paul/Stonewood Address: 2494 Black Lake Road
Project: Demo Valuation: $10,650.00
SEC: Yes Is septic an issue? No Owner permission needed? No
Date Issued: S 1 Inspector Issued: ��'� Number of Days:
Date & Comments
05/16/17
Received application and plans
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❑ Municipality plans at MNSPECT
INSPECTION RECORD
PERMIT NUMBER (7 — ( A DATE 5 1 `—\` \—\
MUST CALL TO SCHEDULE NO LATER THAN THE BUSINESS DAY PRIOR TO THE INSPECTION DAY
q 8:00 A.M. to 4:30 P.M. Monday thru Friday 9 5 2- 4 4 2- 7 5 2 0
Site ` \�'� �\�.C�� �o.�P_ �oa�
Address: Occupancy: Construction: V' Q
Description: �S)ecqmo
Permission is hereby granted to:
Owner•
Contractor: <�\&-'l1 W o0 0
to install or construct the improvements applied for. This permit is
granted upon the condition that the person to whom it is granted, and his
agents, employees and workmen, shall conform in all respects to the
Ordinances
of the Municipality of
and to the Statues of the State of Minnesota in such cases made and provided;
this permit may be revoked at any time upon violation of any of the provisions
of said Ordinances, Statues, or for any misrepresentation in the application.
This card and reviewed construction plans must be.posted at the worksite
and maintained . until all inspections have been approved. NO
INSPECTION will be performed if card and plans are not available to
inspector. REINSPECTION FEE WALL BE CHARGED. NO
DEVIATIONS FROM THE APPROVED PLANS ARE ALLOWED
WITHOUT PRIOR CONSENT FROM THE BUILDING INSPECTIONS
DEPARTMENT. Do not occupy until all final inspections have been
completed.
Permit expires when building and work Is not commenced within
180 days or if building and work Is suspended, abandoned or not
Inspected for 180 days.
REQUIRED INSPECTIONS
Note: Permit holder is responsible to call for these Inspections.
Required Inspections
Date
Inspector
o <
ci►
ca�ove
``
Plumbing Final
Mechanical Final
Electrical Final
Accessibility Final
FINAL