Permits - Permit# 379 - 2494 Black Lake Road - 1/1/1977CITY OF SPRING PARK
P.O. Box 452
4349 Warren Avenue
Spring Park, MN 55384
BUILDING PERMIT APPLICATION
OWNER
ADDRESS 692 L4
BLDR. -CONT. /G"D
Permit No.
DATE o? 7
TELEPHONE 2� ��Z232_
TELEPHONE
Location of Proposed Improvemen/t /
STREET ADDRESS '_q %y.� E'er �L,L/L,A/� / O� �C EST. COST
PLAT G,.�il fS,Sf PARCEL ZONING
COMPLETION DATE_��
Application requirements
Survey ..........' Energy Comp....... Heating Layout..........
Plat Plan ....... Elevations ........ Sewer -Water Location....
Structural Plan...® Watershed.......... County Driveway Permit..._
Other
Types of Construction
NEW CONSTRUCTION REMODELING
Single Family
Sq.
Ft.�
. Addition Sq.
Ft.
Multi -Family
Sq.
Ft.®
,Interior Sq.
Ft.
,® Commercial
Sq.
Ft.
Sub Level. Sq.
Ft.
Industrial
Sq.
Ft.
®Roofing Sq.
Ft. T D
Garage -Size `�Sq.
Ft.`
Siding Sq..
Ft.
Deck -Size
S
Ft.
Utility Bldg. -Size
Patio -Size
®Sq.
Ft.�
Sq.
_Pence -Size
Li.
Ft.�
Plumbing
PERMIT FEE
PERMIT APPROVAL
SURCHARGE �
I
PLANNING COMMISSION
S.A.C. $
COUNCIL
AVAIL. CHG.4
—
OTHER
Total,
In case permit is granted,
I hereby agree to do the proposed
work in
accordance with description
above set forth and according to
the pro-
visions of all ordinances of the
City of Spring Park and of all statutes
of the State of Minnesota in such cases made and provided.
DATE a
APPLICANT
j
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CITY OF SPRING PARK APPLICATION FOR PLUMMNGPERMIT
Box 452 (4349 Warren Avenue)
Spring Park, MN 55384
GENERAL WORK— &'tON
1. You may apply for plumbing permits by mail or in person at the City of$ces.
2. Permit cm,ER
ds will be sent by return mail after a review is completed. PERMITS ARE NOT VALID
UNTIL YOU RECEIVE A PEFUMIT. WORK MUST NOT BEGIN UNTIL THE P1 tMiT CARD IS
POSTED ON THE 10B SITE.
3. Plumbing permits may be issued ONLY to licensed piumbing contractors and to propetty owners residing
in the dwelling.
4_ When any new construction or remodeling is Involved, a separate binding peffiit must be obtained.
5. All work must be done in accordance with the. State Code. requirements.
6. All work must be i_=v and air mmd••before iris cove -red... Cali: 4T3 57._24 hour notice required.
h sstructions Complete all items on this.a hcation.'•Co�
P Pp. mpute..the• permit .fee... Sign. and date
the certification. INCOMPLETE APPLICATIONS WU L NOT BE -PROCESSED. If you have
questions, call 473-7357.
Please check one: New Addition Repair Replace
Residential Commercial
JOB SITE: 2-ggq �✓Ll}C,JZ LICE__ D Zip:
Owner's Name: TelephoneNumber: Y 7 / -
MaffingAddress: 2 y13 �cw, !F, 2D City: IJ6 QKZip:
Cantractox'sName: Q o PAP L oM P" me k3G TeiephoneNumber: 6
MailingAddress: ;26s C 4 e- Fl s�Lp AV6: S City: z 5 Zip: -r. -S •
PLOWING FEKXM- SC$EDULE
FIXTURE BSMT IST ?ND OTHER 11MX.TUU' BSxr TST' 2ND- OTHER
TYPE IFL FL TYPE FL
l IF
I
Warr Closet
,Floor Drains
Lavatory
Sewer Ejector I
Bathtub
I=&.y T=y.
Shoes'
Washer • •
ri,. c ea Sialr
Disposal
Water.Softc=
Disity� rasiyer
5 • � '
We�:•Bar•
Su7laocks
Misc. (Est)
PER Wr FEE CALCULATION
1. 1.25 % of Contract Price_* or Minimum Fee ($35.00)
x .0125
(contract price)
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit. x .0005
(contract price)
or $.50, whichever is greater
3. Po Cage ands (Only mail -in applications)
4. TOTAL PERMIT FEE (Add lines 1-3 above)
$ ' '$7d
$ _ 1.50
$ :32
CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted
work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
customer for the work done. If any material, equipumt, labor, or installation are finished by the owner,
tenant or any other party the reasonable market value of such items must be added to the estimated cost
or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,
the City may request the submission of a signed copy of the actual contract.
The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
g=er. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all
work in strict accordance with the ordinances of the City and the reguMons of the State of
Minnesota, and certifies that all statements made on this application are complete, true and
correct.
Applicant's Signature: Date: 5 �9
259
Miller -Davis Co.,
$- ........... 1�.o12..iJ ............. DLO. ............. -.z.1..�7.......................
Jc•fvl
Rate of filinnesoft, ............. of - ...l .
a
County of---...... ............. Office of ......----- ,
r
�il��I �1i1It
g
IN CONSIDERATI9N OF Theme stlements and representations made by ....................
in........................application therefor
GRANTED To said ................. _......
to..................... V
( build, erect,
in this office, which application is. hereby made a part hereof, PERMISSION IS HEREBY
to, alter, repair, move, wredk, as the case may be)
owner
building described as follows: kind of construction
frontor 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 ------ .......... .......^.......... .........4 plat or addition...
which tract is of the size and area specified in said application.
This permit is granted upon the express conditions that said owner and his contract rs, agents, w en and employees, shall
comply in all respects with the ordinances of the .................. ... .........................------------.of.-: .. that it does
not cover the use of public property, such as streets, sidewalks, lleys, etc., for which sp 1 per is must be secured; and that it does
notcover the following: ...... ................................................................................. -.--.-:.-.-.-................................---- ........................................................
(Electrical work, plumbing, heating, plastering, etc., if such there be.)
for which special permits must be secured.
said .... _................ .........................a its corporate seal and
dayof.............................................19...
Given under the harul of
attested by
A ..