Loading...
Permits - Permit# 17-17 - 2494 Black Lake Road - 1/1/2017CITY OF SPRING PARK PAGE 1 BUILDING PERMIT 4349 Warren Avenue ' I Spring Park, MN 55384 Handout Given Phone: 952-471-9051 Fax: 952-471-9160 Lead Handout Given SITE ADDRESS: 1 �1L R c+- t- A ICE 11r D PID: 7 1) Was the home constructed before 1978? (YES ❑, continue with line 2, NO ❑ continue without completing EPA Section) 2) Will the work disturb t6 sq ft of interior painted surfaces or z20 sq It of exterior painted surfaces? (YES ❑ go to line 4, NO in line 3) 3) Are there any windows being replaced? (YES ❑, go to line 4, NO ❑ continue without completing EPA Section) 4) Has this home been Certified Lead Free? (YES ❑, you MUST Attach Certification Information, NO ❑ complete line 5) 5) EPA Contractor Certification Number: NAT - (applies to contractor only) PROPERTY OWNER: 'A PAF T L Address: ; .. City: c... State: AA N) Zip: Email: 3 I M _ i'AL4A IIALA-E AL. -i • Contact Name: Phone: CONTRACTOR: S N E D j LL, Address: g , 1 City: A- State: Zip: Phone: (aV a o Fax: • Contractor License No: &(-. S 43►5 ContactName: m l-LPhone: i 2_- i Email: e i ARCHITECT: Ek rt-t J)Er_K,,k1 &14NI, Address: I • City: State: Zip: 3 Phone: 1- 4_�3- ' 1 Fax: 3r �Z2 • Email: F- J t2 i E fv DES ' f ' Contact Name: (IL.E"hone: TYPE OF WORK: New Construction ❑ Deck ❑ Re -Roof ❑ Commercial Residential ' ❑ Change of Use ❑ Pool ❑ Re -Side J EST. VALUATION OF WORK ❑ Finish Basement '� ❑ Retaining Wall ❑ Fence $ 7� l ❑ Remodel o Porch ❑ Shed Square feet: ❑ Addition X0emolition ❑ Window/Door Replacement -+sq I ❑ Garage-Attached/Detach ❑ Plumbing -provide detail on Page 2 # being replaced •� Detailed Description of Work: ❑ Accessory Structure ❑ Mechanical -provide detail on Page 2 ❑ Misc Other • Q Signature of this application by the legal property owner or a licensed contractor, as the owners representable, is required and authorizes the Zoning Administrator or designee and the Building Official or designee to enter upon the property to perform needed inspections. Entry may be without prior notice. I hereby acknowledge that 1 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 abide by all ordinances of the Municipality and the laws of the State of Minnesota regarding actions taken pursuant to this permit. I agree to pay all plan review fees even H I choose not to proceed with the Permit •• work expires when work is not commenced within 180 days from date of permit, or if work is suspended, abandoned, or not inspected for 180 days. Work beyond the scope of this permit, or work without a permit or inspection, 'll • be subject to a penalty. Noise Ordinance In Effect: MONDAY - FRIDAY Before 7 a.m. and after 10 P.M. Weekends/Holidays before 7 a.m. and after 8 p.m. SIGNATURE OF APPLICANT: DATE:_ 3.7.4 PRINTED NAME: J t., •Tt` _ This is the signature of: ❑ Owner or X Owner's Representative OCCUP. TYPE:' - CONST. TYPE: LIP, CODE: Z BLDG SPRINKLED Yes o VALUATION:- $ 7�i �''�� Permit Fee: $ -7 Mu vs- WAC Charge: $ Plan Review Fee: $ IC1115181 2 Sewer & Water Hook -Up: $ State Surcharge: $ Sewer & Water DisconnecQ..cbe Site Inspection Fee: $ Water Mete S.E.C. Fee: $ Muni SE/WA Fee J Investigation Fee / Other Fee: $ Copy Charge ($.25 per 8.5 x11 page) $ *2016 SAC Escrow zz LSC� License Check ($5) / Lead Check ($5) $ �C>C) Othe TOTAL DUE,a to SUB -TOTAL $ 7 iy/ M Plumbing Fee (from Page 2) $ �e�� *NOTE: Commercial plans will be submittedil Environ I Svcs w C� Mechanical Fee from Page 2 $ • Q for SAC determination. Escrow payment wen s Issued. tf after Met Council review no SAC Is deterbe LL U. _ Special Conditions/Required Setbacks: refunded In full. Building Approval By: DATE: Printed Building Approval By: r License Verification ❑ Lead Verification - Checked By: City Approval By: DATE: Paid:,,7 9 6, a2 Date: if 9 I % Receipt No. By: Poor Quality.Document Disclaimer The original or copy of a document or page of a document presented at the time of digital scanning contained within this digital file may be of substandard quality for viewing, printing or faxing needs. CITY OF SPRING PARK PERMIT I �I 11i'1 0 PLUMBING PERMIT PAM Z FOR PERMIT ISSUANCE PAGE 1 and PAGE 2 sbeuld be aompteta MECHANICAL INFORMATION tMedtorigl Contactor: 'z O "Thc�gddrees: car, Stall: Do- S Pho a: / J - Foc State Bond No: M a oo 31 q Email: h Cwftd Ph 6 _ ' Dam of Work: C xle Irk type of pn4e0t, fbct M, and Gans Lines you WM be or neplemV (mdude count for each type of fuchue): 111ECHANWCAL FD[t'URES GAS LDS Fumace _L Kitchen Fan Face Air Camillioning System _ 7 Bath Fen Ftreptace Air Euhanger Gr11 Unit Fleahm Fireplace VAft Heeler Urst Heater / Go In Flow Heat / DW Gas Lon I -Stowe a R (one ftWre only, no plIft or vein drerhges) Medwko Pemdt Fee: $ 2 on O Additio vRem M Gas Lure Permit Fee: S New cowhection State' s �n o Other Other $ �� Total lilac hankal Pere t $-413. c � , INFORMATIONPLUNIBING ndt = Phone: Fwc Plnmbrs License Na State Bond No: n1atd None: ctxaaa Pthorre: Email: Dotalled Depulption of Work: Indicate type of project and fbdures you WW be kwialling or replacing (include count for each hrpe of fedure): Water Hedw Show ' Laundry Tub o Gas o Electric Dishwasher Rough -In Future Fbdure Wale; Sof ter Clothea vvasher Sufm Lawn Sprihlder System lee Moloch Lire Water P$>trhg Sydwn V1/Mer Closet (Totieq Hose Bib Floor Drain Layakuy Basin Bathtub o Replacement (one fsdrre only, no POIng or vent changes) oeaea tetra � Plumbing Permit Fee. $ a AddilloNRanctiel Stele Surcharge $ o New Consenacdon onrer: $ 13 Other Total Plumbing Permit $ CITY OF SPRING PARK ❑ MECHANICAL PERMIT PLUMBING PERMIT f PAGE Z FOR PERMIT ISSUANCE PAGE 1 and PAGE 2 should be complete MECHANICAL•' • Mechanical Contractor. Address: State: Zip: Phone: Fax: State Bond No: lContact Name: Email: Contact Phone: Detailed Description of Work: Indicate type of project, fixtures, and Gas Lines you will be installing or replacing (include count for each type of fixture): MECHANICAL FWWRES GAS LINES Quanity Quanity Quanity Furnace Kitchen Fan Furnace Air Conditioning System Bath Fan Fireplace Air Exchanger Grill Unit Heater Fireplace Water Heater -7 b 0 8 Unit Heater Grill In Floor Heat Dryer Gas Log Stove Onke Use Only: ❑ Replacement (one fixture only, no piping or vent changes) Mechanical Permit Fee: $ D Addition/Remodel Gas Line Permit Fee: $ ❑ New Construction State Surcharge: $ ❑ Other Other: $ Total Mechanical Permit: $ PLIJ M BIN GA NFORMATION Plumbing Contractor: 5 s- m e - Address: 130a5 Gin✓' < Wck tr I3�7)'✓e Su.ic tH l city:6 t r S State: N Zip: 3 Phone: 3- ya r- l f 3 3 Fax: N 3- 4a e- 173 3 Plumbers License No: PM D (n 13LN State Bond No: M6 6 6 3a (na- Contact Name: en l- gu !C er Contact Phone: i (p 3 - ya �- / b' 3 3 Email:Mt S{ewurt !!/mbir���'nc.ref Detailed Description of Worts: Indicate type of project and fixtures you will be installing or replacing (include count for each type of fixture): PLUMBING FD(TURES uan (3,uanIbL Quanity I_ Water Heater _ . Shower I Laundry Tub ❑ Gas ❑ Electric Dishwasher Rough -In Future Fixture Water Softener �_ Clothes Washer I Sump Lawn Sprinkler System I_ lee Maker Line I Water Piping System _ Water Closet (Toilet) 2 Hose Bib 1 _ Floor Drain 7 Lavatory Wash Basin c� Bathtub office Use only. ❑ Replacement (one fixture only, no piping or vent changes) Plumbing Permit Fee: $ ❑ Addition/Remodel State Surcharge $ CXJ ❑ New Construction Other: $ ❑ Other Total Plumbing Permit: $ CITY OF SPRING PARK PAGE 1 BUILDING PERMIT 4349 Warren Avenue Spring Park, MN 55384 El Handout Given r I Phone: 952-471-9Q051 Fax: 952-471-9160 ❑ Lead Handout Given SITE ADDRESS: F SLA'-fL A ICE fir- D PID: 19 ' I I - Z3 ` jZ 0613 1) Was the home constructed before 1978? (YES ❑, continue with line 2, NO ❑ continue without completing EPA Section) 2) Will the work disturb Z6 sq ft of interior painted surfaces or >_20 sq ft of exterior painted surfaces? (YES ❑ go to line 4, NO ❑ line 3) 3) Are there any windows being replaced? (YES ❑, go to line 4, NO ❑ continue without completing EPA Section) 4) Has this home been Certified Lead Free? (YES ❑, you MUST Attach Certification Information, NO ❑ complete line 5) 5) EPA Contractor Certification Number: NAT - (applies to contractor only) PROPERTY OWNER: >v " Avg-, Address: 2 t Mgt j� Ci a State: i✓ Zip: 'Z- Email: -3(M1 _ PN I.l E L Contact Name: Phone: • CONTRACTOR: 5 Ni o0D I.C. Address: S £ city: A- State: zip: Phone: d Fax: Contractor License No: b C il 9- 31 S Contact Name: —'E- rn i.l hone: I Z- - 3 Email: Mot 2 e ARCHITECT: FxAN,,t_T_ DEC16tl Address: I i City: /` State: Zip: 3 Phone: S2- 4-43- - Fax: • Email: F- G �E N DES f . CL Contact Name: CILFRPhone: TYPE OF WORK: ,New Construction ❑ Deck ❑ Re -Roof ❑ Commercial AResidential ❑ Change of Use ❑ Pool ❑ Re -Side EST. VALUATION OF WORK ❑ Finish Basement ❑ Retaining Wall ❑ Fence $ '-7- 20 4000 ❑ Remodel ❑ Porch ❑ Shed Square feet: ❑ Addition x 3emolition ❑ Window/Door Replacement 3 ❑ Garage-Attached/Detach ❑ Plumbing -provide detail on Page 2 # being replaced Detailed Description of Work: ❑ Accessory Structure ❑ Mechanical -provide detail on Page 2 ❑ Misc Other f, Tr FA^1 t C P, v _ • Signature of this application by the legal property owner or a licensed contractor, as the owner's representative, is required and authorizes the Zoning Administrator or designee and the Building O]and or designee to enter 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 all information is true 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 abide by all ordinances of the Municipali and the laws of the State of Minnesota regarding actions taken pursuant to this permit. I agree to pay all plan review fees even If I choose not to proceed with the work. Permit expires when work u is not commenced within 180 days from date of permit, or if work is suspended, abandoned, or not inspected for 180 days. Work beyond the scope of this permit, or work without a permit or inspection, • will be subject to a penalty. Noise Ordinance In Effect: MONDAY - FRIDAY Before 7 a.m. and after 10 p.m. Weekends/Holidays before 7 a.m. and after 8 p.m. SIGNATURE OF APPLICANT: r A Lf DATE: 3-.. 4 • �'� PRINTED NAME: Ilk J 11111-a-F 11- V V -L %A_1E'1.__ This is the signature of: ❑ Owner or X Owner's Representative OCCUP. TYPE: CONST. TYPE: CODE: BLDG SPRINKLED Yes / No VALUATION: $ Permit Fee: $ WAC Charge: $ Plan Review Fee: $ Sewer & Water Hook -Up: $ State Surcharge: $ Sewer & Water Disconnect: $ Site Inspection Fee: $ Water Meter: $ S.E.C. Fee: $ Muni SENVA Fee: $ Investigation Fee / Other Fee: $ *2016 SAC Escrow: $2,485 J Copy Charge ($.25 per 8.5 x11 page) $ Other: $ z0 License Check ($5) / Lead Check ($5) $ TOTAL DUE: $ SUB -TOTAL $ 0 3 Plumbing Fee (from Page 2) $ *NOTE: Commercial plans will be submitted to the Met Council Environmental Svcs for SAC determination. Escrow payment will be required when permit Is Issued. If W Mechanical Fee from Page 2 $ after Met Council review no SAC is determined, escrow will be refunded in full. V LL Special Conditions/Required Setbacks: ILL Building Approval By: DATE: Printed Building Approval By: ❑ License Verification ❑ Lead Verification - Checked By: City Approval By: DATE: Paid: Date: Receipt No. By: CITY OF SPRING PARK UBCAL PERMIT ❑ PLUMBING PEVJMT PAGE 2 FOR PERMIT ISSUANCE PAGE t and PAGE 2 should be complete MECHANICAL•' • Medhmhleal Contractor. 'z OPa. ars 'ttemdress: CW, State zl: ;9022 Phone: score Bond No: 1►% Oo 31 ak loordedName: fhikp Contact Plhorhe: 6 - Emall: Delsftd of Work: A Ire-v0 C Indicate type of project, Wares. and Gas Lines you wiN be lnstaNing or replacing (mclude count for each type of facture): MECHAAWAL ADfrilRES CAS LAVES Furnace I_ KWW Fan Furnace Air CWWW0f&Q Syslern —Z_ Batt► Fan Fireplace Air Exdonger Gr®I _(_ Unit Heater Fireplace Water Heater Unit Hewer / Grit In Floor Hest / Dyer Gas Log I Stove OfRae fArs aMY•• o Replacement (one future only, no piping or vent changes) Mechanical Permit Fee: $ Gas Line Permit Fee: $ *New Construction state Surcharge: s o Other other: $ Total Mechanical Permit: i . L U M B I N G INFORMATION Contractor Ad ' - p - stare Phone: Fac Plumbers License No: Sbsre Bond No: Contact Narne CwdW Photo: Emall: Delalled Description of work: IndccaW type cf project and fbdures you w®tzDc7i RE dafft or ring Cmdude count or each type of facture): Water Heater hahrer Laundry Tub o Gas o Electric Dishwasher Rough -In Future Fbdure wow Softener Clothes Washer SUMP Lawn Sprit w System Ice Maker Line Minter Piping System Water Closet (Toma Hose Bib Flo" Drain Lavatory ~ 8asbr Beldub cane& am o ay: o Reptacement (one ibdure only. no PON or vent changes) Plumbing Permit Fee: s State Surcharge $ o New Contraction Other: $ o Other Total Plumbing Permit: $ CITY OF SPRING PARK ❑ MECHANICAL PERMIT ❑ PLUMBING PERMIT PAGE 2 FOR PERMIT ISSUANCE PAGE 1 and PAGE 2 should be complete MECHANICAL INFORMATION Mechanical Contractor. Address: CRY: State: Zi : Phone: Fax: State Bond No: Contact Name: Email: Contact Phone: Detailed Description of Work: Indicate type of project, fixtures, and Gas Lines you will be installing or replacing (include count for each type of fixture): MECHANICAL FXTURES GAS LINES Quanity Quanity Quanity Furnace Kitchen Fan Furnace Air Conditioning System Bath Fan Fireplace Air Exchanger Grill Unit Heater Fireplace I Water Heater -N oo o 8 Tv Unit Heater Grill In Floor Heat Dryer Gas Log Stove olilce Use Only: ❑ Replacement (one fixture only, no piping or vent changes) Mechanical Permit Fee: $ ❑ Addition/Remodel Gas Line Permit Fee: $ ❑ New Construction State Surcharge: $ ❑ Other Other. $ Total Mechanical Permit: $ PLUMBING INFORMATION Plumbing Contractor. Jr Q, in C • Address: 130a5 6to < U 6k;L?' ail%✓e Sufic l C' e r S State: MIV Zi : 3 q Phone: -7 3- qd Y" l t 3 3 Fax: /o 3- 4a k- I73 3 Plumbers License No: Pm D (v /3NN State Bond No: M8 D b 3ato� Contact Name: XenL 8a leer Contact Phone: 7 47 Email: kfnt Skwart lumbi4 nc.nef Detailed Description of Work: Indicate type of project and fixtures you will be installing or replacing (include count for each type of fixture): PLUMBING FIXTURES an (QuanIbL Quanity _ I Water Heater _ _� Shower �_ Laundry Tub ❑ Gas ❑ Electric Dishwasher Rough -In Future Fixture Water Softener Clothes Washer Sump Lawn Sprinkler System Ice Maker Line Water Piping System J Water Closet (Toilet) Hose Bib L_ Floor Drain _ 7 Lavatory Wash Basin c� Bathtub ornoe use Only: ❑ Replacement (one fixture only, no piping or vent changes) ❑ Addition/Remodel Plumbing Permit Fee: $ State Surcharge $ ❑ New Construction Other: $ ❑ Other Total Plumbing Permit: $ Date Received S at city Hall: Application For Demolition Permit Permit #: City of Spring Park, Minnesota Fee: Based on Valuation and Requires a Building Permit Name: S 7-0 �.+i; t., b�� L_l_ C_ Telephone No.: 00 Address: 5 L Ai-,E �-r 1^1 A-�-L I Demolition Property Address: G 4 of A- V�L A%-V- L {-t,E �p Type Of Structure: S T Va w. E Approx Date To Begin: q • 1 1). 17 Estimated Completion Date: Utilities On Site: Check (✓) all that apply Sewer Water ✓ Electric Cable �� Gas �L Telephone Note: It is the Owner's or Contractor's responsibility to contact GOPHER STATE ONE CALL at 1-800-252-1166 to notify of the disconnect and to mark any underground utilities on the property. Will Utilities Be Used For New Structure? .................. Yes No Note: If water and sewer services are never to be reused, the property owner is responsible for abandoning services according to Minnesota State Plumbing Code and must be inspected by the City of Spring Park Public Works Department. Is There a Water Well On Site? .................................... Yes No Is There An Underground Fuel Tank? .......................... Yes No Demolition Contractor: 5 r- Telephone No. Address: 2!) 1 (o F �xr--� e-pP,1SE M KI Liability Insurance Co. 04", L. 5 Telephone No. 76Z-653-160CD Policy No: fo G Y5'Y 1 V 3 CGS+', ,sar- 6,­�, It"s. Policy Period From: l/ l To: "I -%L Coverage And Limits: �7(ljz Note: In the event that any ASBESTOS is present in the structure, state approved methods must be followed. I hereby declare that I am the owner of the property or the demolition contractor of above described property. I agree to comply with all state regulations and all materials from the demolition will be taken to a state approved demolition dumpsite. All the foregoing information contained on this permit is a true and correct statement of my intentions. Signed By Applicant: �l Date: �j Z4 1 7� Permit Approved By: Title: Date: The Following Section To Be Completed By City Officials Total Fee: Receipt No: Received by: The Following Section To Be Completed By Public Works / Operator Water Service ............Disconnected Abandoned Sealed Signed Sewer Service ............ Disconnected Abandoned Sealed Signed Electrical Service....... Disconnected Abandoned Removed Signed Gas Service ...............Disconnected Abandoned Removed Signed Page 1 of 2 All of the foregoing requests must be completed and signed -off PRIOR to the start of any demolition. The undersigned owner/contractor hereby agrees as follows: 1. The structure shall be kept enclosed and/or secured until such time as demolition is complete. 2. Demolition debris will be kept off adjoining property and/or the public rights -of -way unless specific, prior approval is obtained in writing for temporary use thereof. 3. Foundations shall be completely removed from the ground. 4. All demolition debris shall be completely disposed of off site in accordance with all applicable PCA requirements. 5. Water wells must be abandoned in accordance with the State Health Department regulations. 6. Inspection required when all debris has been removed — before backfilling. 7. Within five working days of superstructure removal, a final inspection shall be requested. The site shall be left clean and clear of all debris, with any excavation filled with earth level with the adjacent ground elevation (except when such excavation is to be used as part of a new building and such new building is actually under construction). 8. Septic systems must be abandoned per MN Rules Chapter 7080. All septic tanks must be pumped, crushed and filled with native soils. An inspection is required after the tanks are pumped and before the tanks are crushed and filled. 9. The undersigned owner shall and hereby does indemnify and hold harmless the City of Spring Park, its agents, employees and assigns from and against all claims, damages, losses or expenses, including attorney fees, against the City, its agents, employees and assigns arising out of or resulting from the demolition described herein as performed by the property owner, his employees, agents, subcontractors or assigns. The undersigned hereby applies to the City of Spring Park for issuance of a Demolition Permit, agrees to do all the work in a strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on t is application are in lete, true and correct. Applicant's Signature Owner's Signature Approved By: Page 2 of 2 WATER RESOURCE PERMIT APPLICATION FORM Use this form to notify/apply to the Minnehaha Creek Watershed District (MCWD) of a proposed project or work which may fall within their jurisdiction. Fill out this form completely and submit with your site plan, maps, etc. to the MCWD at: 15320 Minnetonka Blvd. Minnetonka, MN 55345. Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. 1. Name of each property owner: James Paul Mailing Address: N t,\) City: pf-le L State: A)A) Zip: Email Address: jim_paul@valleycardealers.com Phone: a/2 Z7c-3/�Z— Fax: 2. Property Owner Representative Information (not required) (licensed contractor, architect, engineer, etc...) Business Name: Stonewood, LLC Representative Name: Nate Mitchell Business Address: 153 Lake St E City: Wayzata State: MN Zip: 55391 Email Address: nate@stonewood.com Phone: 612-251-9713 Fax: 3. Project Address: 2494 Black Lake Road City: Spring Park State: MN Zip: 55384 Qtr Section(s): Section(s): Township(s): Range(s): Lot: 5&6 Block: Subdivision: Skarp&Lindquists Rose Hill PID: 19-117-23-12-0023 4. Size of project parcel (square feet or acres): 27799 sq ft Area of disturbance (square feet): 6000 Volume of excavation/fill (cubic yards): Area of existing impervious surface: Area of proposed impervious surface: 5963 Length of shoreline affected (feet): 0 Waterbody (& bay if applicable): Black Lake/Lake Minnetonka 5. Type of permit being applied for (Check all that apply): 0 EROSION CONTROL ❑ WATERBODY CROSSINGS/STRUCTURES ❑ FLOODPLAIN ALTERATION ❑ STORMWATER MANAGEMENT ❑ WETLAND PROTECTION ❑ APPROPRIATIONS ❑ DREDGING ❑ ILLICIT DISCHARGE ❑ SHORELINE/STREAMBANK STABILIZATION 6. Project purpose (Check all that apply): * SINGLE FAMILY HOME ❑ MULTI FAMILY RESIDENTIAL (apartments) ❑ ROAD CONSTRUCTION ❑ COMMERCIAL or INSTITUTIONAL ❑ UTILITIES ❑ SUBDIVISIONS (include number of lots) ❑ DREDGING ❑ LANDSCAPING (pools, berms, etc.) ❑ SHORELINE/STREAMBANK STABILIZATION ❑ OTHER (DESCRIBE): 7. NPDES/SDS General Stormwater Permit Number (if applicable): 8. Waterbody receiving runoff from site: Black Lake/Lake Minnetonka 9. Project Timeline: Start Date: 4.10.17 Completion Date: 1.15.18 Permits have been applied for: City 13 County ® MN Pollution Control Agency [3 DNR ® COE 13 Permits have been received: City ---Q County --Q MN Pollution Control Agency DNR­M COE—M By signing below, I hereby request a permit to authorize the activities described herein. 1 certify that I am familiar with MCWD Rules and that the proposed activity will be conducted in compliance with these Rules. 1 am familiar with the information contained in this application and, to the best of my knowledge and belief, all information is true, complete and accurate. I understand that proceeding with work before all required authorizations are obtained may be subject to federal, state and/or local administrative, civil and/or criminal penalties. ,/'> 3.'Z6r-17 Signature of Each Property Owner Date Revised 7/15/13 Page 1 of 1 EROSION CONTROL SUPPLEMENTAL INFORMATION FORM INSPECTION PLAN REQUIREMENTS 1. Routine Inspections: Once every seven days during active construction Within 24 hours of a half inch or more precipitation 2. Completed Field Inspection Reports: • Reports available within 24 hours of request until MCWD determines project is complete & stabilized Failure to submit requested inspection information will result in a site inspection and may be subject to reimbursement for MCWD staff time. Who will inspect your site regularly? NAME: N ft-r", M 17, It PHONE: G l Z - Z�- I - 21- 13 ORGANIZATION: S-p tir, oop ALTERNATE PHONE: 6 (Z- 46 2- how EMAIL: 4) 0,1 e (;� c ie)v\ e wm d Gawp Where is the concrete washout location? d OFF SITE OR CONTAINED ON TRUCK ❑ INDICATED ON SITE PLAN (with required impermeable liner) ❑ N/A What is the final stabilization method? (seed, sod, etc.): 5 o 1> 6 inches of topsoil must be added/replaced prior to final stabilization Will protective fencing for retained vegetation. be installed? YES ❑ NOT APPLICABLE ❑ OTHER (describe) I certify that I am familiar with thZ ements of the MCWD Erosion Control Rule and that the proposed tivity will a conductepliance with this rule. �•2.�-I�Signature of Applicant or Authorint Date MINNEHAHA CREEK WATERSHED DISTRICT �� QUALITY OF WATER, QUALITY OF LIFE Construction Staging Plan and Narrative: 2494 Black Lake Spring Park Completed by Nate Mitchell, Stonewood, LLC; May 8, 2017 1. Parking of workers: no on -street parking on Black Lake Road will be allowed. We will park on Shoreline Dr or at Spring Park City Offices at 4349 Warren Ave. Thank you Spring Park for this offer to help facilitate our project. 2. Location for the staging of equipment, materials is designated on the survey attached 3. Material Deliveries will be scheduled in the morning after rush hour and later afternoons before rush hour 4. We will require subcontractor vehicles to safely and properly navigate Black Lake Road with the limited space and immediacy to the neighboring homes and structures and with limited space to turn a vehicle around. Being the end property should provide us advantages of being able to turn around on our property S. Location of dumpsters, Biffs and other accessory items have been noted on the survey S 8A --�- BOUNDARY AND TOPOGRPHIC SURVEY FOR JIM PAUL IN LOTS 5 & 6e SKARP & LINDQUISTS ROSE HILL HENNEPIN COUNTYF MINNESOTA EXCEPT/ON£XCEP7/ON `v,,} 6 s1aeF`sa' wea Qcviso V9.0 45 of .•�_ .-ea.a. �s 0 LEGAL DESCRIPTION OF PREMISES M a lad 6, arm 4et pan a lot 8, Skwp and LkdW to Roe HS Addlom. New l:wedY. Minroswo, a®pt lerW tloef®ad se tdwm Dam:lrwa>trV m iM NwN W a sold Lw 8, m a pvW St am Vim of the Nort eam owner erwaol, Norm m d8ha elpbe m a pohn b west SauN a1M North lire a sale Lot Nano 6e SermfN m�ae iaahmndae Nwo. towns a no old lot Swe Wad" moo the NorthAbe ameq tnm pad a lot 6orrarrrdnp at a palm to the North W of oW Lot 87 tam Wed dSe Nmdeed LenWLtmm�wspmamSS 1M Swdh atNe NorthWlada mso" e>mnWd awn ems palm are the No OMW most Of nW tot to a Weawdt W a WM lot tlrmlea Nmtlery sbry sold wed" W to the Nolpnem carer at sold Lot tom OWN* MM to No' N fro Nmedm tle pmm� PROPOSEDNMG OCOVFR LQ1lATtON6 Tlds outlay mloe 1M aM mpopra�ay aNe aMaa deaaree0 PUPwb. wen tie bmtlorl a sn wamap Imo. �r�a wen ekm tread Noreen. wen the PW�d location DSSTINO LOT T779B�- S.F. a e p oposed Moe pwdl end dMe.aY. d dm nm p rW m ahpe wy omer 6np� nerds or woosdeerb. PROPOSED NOLISE 2622. S.F. PROPOSED DRIVEWAY 2871� e : wan nmfkw%Lmd wr0FeaEnpavA11aNlMAreimECLVBW" PROPOSED PORCH 2O1+- -1 F= Cc W PROPOSED WALL 158n . Prapoasd terdola W 10 20 40 UMFu7w1 •eels ®: Prepoase epol ebvadon I i� ;am TOTAL d88S•• 9.F. �ivl ropWMV`r •awAewn 69612Tt88.21A15% SCALE IN FEET GRONSERG & ASSOCIATES, INC. mCw aL MLLOW DRIVE LOW LIKE. MIN UM ACORO `� INSURANCE BINDER [—'6AT(MM/DD/YYYY) 11E /1/2016 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON PAGE 2 OF THIS FORM. AGENCY COMPANY INDER # Christensen Group Insurance United Fire & Casualty �:1611126420 11100 Bren Road West DATE EFFECTIVE TIME DATE EXPIRATION TIME AM X 12:01 AM Minnetonka MN 55343 11/7/2016 12:01 PM 12/19/2016 NOON N PHONE C No Ext : 952 65 3-1000 FAX No : ( 952) 653-1100 THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY PER EXPIRING POLICY #: 604 5 414 3 CODE: SUB CODE: AGENCY C TOMERID: 00045741 DESCRIPTION OF OPERATIONS/ VEHICLES/ PROPERTY (including Location) LOc# 00001 INSURED AND MAILING ADDRESS STONEWOOD LLC 153 Lake Street East 153 Lake Street East Wayzata, MN 55391 Wayzata I MN 55391 l�iaJ'I a'r_Lei ;;w TYPEOFINSURANCE COVERAGE/FORMS DEDUCTIBLE COINS%,,• AMOUNT PROPERTY CAUSES OF LOSS BASIC BROAD lxl SPEC Backup - Sewers and Drains, Special form Building, Special form Business Income/EE-Inc Loss Rents, Special form Business Personal Property, Special form 1,000 1,000 1,000 90 90 50,000 1,068,000 200,000 216,400 GENERALUABILJTY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR Each Occurrence, $1,000 RETRO DATE FOR CLAIMS MADE: EACH OCCURRENCE $ 1,000,000 %{ DAMAGETO RENTED PREMISES $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 VEHICLE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Combined single limit PIP -Basic Uninsured motorist combined single limit 2012 Dodge/Ram 1C6RD7LTOCS342042 COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ MEDICALPAYMENTS $ PERSONAL INJURY PROT $ UNINSURED MOTORIST $ 1,000,000 Underinsured $ 1,000,000 VEHICLE PHYSICAL DAMAGE DED X rCOLLISION: 500 X OTHER THAN COL: 500 ALL VEHICLES SCHEDULED VEHICLES ACTUAL CASH VALUE $ STATED AMOUNT GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACHACCIDENT $ AGGREGATE $ EXCESSLJABILITY X UMBRELLA FORM OTHER THAN UMBRELLA FORM Umbrella (C) RETRO DATE FOR CLAIMS MADE: EACH OCCURRENCE $ 2,000,000 AGGREGATE $ SELF -INSURED RETENTION $ WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY PER STATUTE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ SPECIAL CONDITIONS / OTHER COVERAGES FEES $ TAXES Is ESTIMATED TOTAL PREMIUM $ I�f1mG Q /1V Vll G�7 �7 MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN #: AUTHORIZED REPRESENTATIVE Brandon Perkins/BARBM�� ACORD 75 (2013/09) INS075 (2013091 Page 1 of 2 ©1993-2013 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Construction Staging Plan and Narrative: 2494 Black Lake, Spring Park Completed by Nate Mitchell, Stonewood, LLC; May 8, 2017 1. Parking of workers: no on -street parking on Black Lake Road will be allowed. We will park on Shoreline Dr or at Spring Park City Offices at 4349 Warren Ave. Thank you Spring Park for this offer to help facilitate our project. 2. Location for the staging of equipment, materials is designated on the survey attached 3. Material Deliveries will be scheduled in the morning after rush hour and later afternoons before rush hour 4. We will require subcontractor vehicles to safely and properly navigate Black Lake Road with the limited space and immediacy to the neighboring homes and structures and with limited space to turn a vehicle around. Being the end property should provide us advantages of being able to turn around on our property S. Location of dumpsters, Biffs and other accessory items have been noted on the survey I'Oau �cl � S 6,1 - BOUNDARY AND TOPOGRPHIC SURVEY FOR JIM PAUL IN LOTS 5 & 6, SKARP & LINDQUISTS ROSE HILL HENNEPIN COUNTY, MINNESOTA p0g^WD 49 u a. E X C E P'T I O N �8 E X C E P T I O N p � V 6 s1rM • Rs1r15aD pp-UIF IA To PtIluti 1ST `NG t } 2ATM ;\ 5 i �tJG / 0 LEGAL DESCRIPTION OF PREMISES SURVEYED: AN of Lot S. eW ReroWloCarsq. Vod8Lu[mn Mlnnad,®orfoam: North am of arreol erepta m ea PoIM a81mt Boni mi No1N sired Mama � Ore direct line to them are po6a d NQansd comer at JIM Lot thence W dwto Wom the N Alwmmep art Fend Ld wmrei" at a point In to North Gre of oW Lob 1117lbel West of the Nortlread rmror d seld laC teorm Borah d rbm onpb lo a pose 3S 6d Soe@r dOre North errs d cola lee; turret Ina WalmtV aom aald pdm ebrq a Ihre amaMea aoe wN pours end to Nml - comerdaloLottoa Wared7ernedaNLM tr- Nmtlut7 amp ald Waffidr aru to the NoMmust comer d said lay ttenoa Eadwv ebm are Nora err t eredLo the po6a d 4e�ucop. TNa ervray elroaa Ore baoftTartee ant dire store tew®et VOFerh. Ord tre loodlon d ore j. p horIDa, gergl, e, aM elpnalortl tea Orereon, towers proposed location EXISTING LOT 27789•- &F. of a papered Imrre, pordr ald drNerwey. t does not purport lo drove arty Darer hrrprers rtrrrU a aFraradrrerm. PROPOSED HOUSE 2 w S.F. PROPOSED OpOVEWAY 7117t - e ��d PlAPMnev TKOIS�r�rreCr.%IRF'Il PROPOSED PORCH PROPOSEDWALL 1fi�S--. . FYoposed rnrrlora lore p 10 70 a0 ®: Proposed epd elevation jswwt{ ~—i IWORM r FLOOR •9514 WAM :eWoor TOTAL - S.F. I t Taro From •s®a.®a 596&7r w-t1AI5% AI 6CALE IN FEET GRONBERO & ASSOCIATES, INC. a aumr ei 44-55 e+n CRIL rs, LAID eetm1210= rAeo sea N. WLLLOW DRIVE LONG LAD' all MU pNONE:aS3g3i1N FAI:/57d73M7o errs FOR CITY USE ONLY Date Received: Permit N ❑ In -House SAC Determination Form Completed Approved By (If Required): . Remarks: ffib3flH@ UAIFDIR7 on Lake Minnetonka 4349 Warren Ave Spring Park, MN 55384 952-471-9051 CITY OF SPRING PARK — SEWER & WATER / GENERAL PERMIT (• Note: Some permits may require approval by the Building Official and/or Public Works Department •) (ALL PERMITS - May be subject to further review and may not be issued when the application is received) GENERAL INFORMATION 1. You may apply for utility permits by mail or in person at the City offices. 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will be sent by return mail within 2 business days. 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless the permit card is available on the job site. 5. Utility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Department (952471-9051) for utility stub as -built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit does not grant this approval. 7. All work must be done in accordance with State Code requirements. 8. All work must be inspected before it is covered. Call (952) 471-9051, 24+hour notice required. TYPE OF PERMIT (Check All That Apply Residential (May Require Approval) Ll Commercial (Approval Required) Industrial (Approval Required) ❑ New Connection ❑ Additional Connection [liRe-Connection ❑ Repairs [Disconnect ❑ Water Availability Connection for Future Hook -Up to Water Job Site / Owner Information: Site Address: 2,J 14 T >LAz-__,_l_/t-x p . Owner: Mailing Address: 1- 4 827 City: 7 ?- t v rt_. %, A�.- ti%E Zip: Home Phone: 6 I Z' �� ��' 3 � �— Alternate Phone: Contractor Information: Contractor: l.l, c, Contact Person: Address: 1 53 L S 7. e State License #: City: ,,,,1r'i:�- kr-,a Zip: 5331( Expiration Date: s<-3-1Z ,U A r-t m I TZ N - 13c,"4-3 is- - 3 L31 16 Phone: Z Alternate Phone: i 7- 1 macintosh hd:users.j asonphillips: downloads: spring park sewer & water permit.docx DETERMINING PERMIT FEES ❑ SAC Charge (2016 Rate = $2,485.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Spring Park City Staff can determine if applicable) (If not prepaid, a sewer connection permit will not be issued) ❑ Sewer Connection / Disconnect / Repair ($50.00/Per Stub) Pipe size inches; material Schd 40 air tested; ❑ Water Connection / Disconnect / Repair ($50.00/Per Stub) Pipe size inches; material air tested; copper ❑ Water Availability For Future Hook -Up to Water ($50.00) Water Availability Explanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Required Before Water Connection Permit is Issued: 1. Issue Water Meter & Horn Permit 2. Any Additional Connection Fees Paid (If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee & Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: 2. STATE SURCHARGE 1.00 3. POSTAGE & HANDLING (Only on Mail -In Applications) $ 2.00 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) ADDITIONAL INFORMATION — WATER METERS ■ WATER METERS must be picked up and paid for at Spring Park City Hall, these are on a separate permit. ■ WATER METERS must be set and sealed by Spring Park Water Department (952) 471-9051, upon completion of meter installation. The undersigned hereby applies to the City of Spring Park for issuance of a Utility Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are, true and correct. Applicant: Date: Revised: 4/2 20 SEWER & WATER PERMIT 2 macintosh hd:users.j asonphillips:downloads: spring park sewer & water permit.docx IN HOUSE FORM - TO HELP DETERMINE SAC UNITS 1� (* Please:Key This Intormat,on On Comment Lme Of Permit *)•' ai' ,k w .,ompleted ,5 #:Of SAC Umts i Completed By s y i x *SAt 'Previously Psid •` PeFmrt # -7<: �'��_ '-} �, te of Permit_, • Charge ,h SAC Unit Per Home * If Multiple HomestOr Units' May Need To Pay Additional SAC Charges r ` +SAC G"randfatfieredaln ' ` ✓ w Permit # P . Date of Permit * ,Must have had,Hook Up'& Home Prior To;January 11973 4 z: • Refer to Helpful Hint: Sheets; Or Ask If Necessary v ; *_If Multiple'Uni't's=Ma'y'Nec:d,To�'Pay,,AddiiionfSAC Charges i ` _ -• n It ,L t._ a�t" Commercial y. }. Permit #,"Accounted For'- #�1)ate of Permit; i (] Letter From MeY Council Showing Used= Or Add�honal Units'Needed' �v* Contact Met C.ouncihif651,.602 1:421.To Obtain Letter; Copies' To DJ Street File' One mrt On,,Copy OtTenFor'Reporting ' unable to determine, will have to wait:to be issued untW&terminatidfi can be'made �t Needs Approval From Public Works Approved Bypy I' 3 macintosh hd:users:jasonphillips: downloads: spring park sewer & water permit.docx