Permits - Permit# 04-06 - 4317 Channel Road - 1/1/2004r
CITY OF SPRING PARK
4349 WARREN AVEN U E
SPRING PARK, MN 55384
952-471-9051 FAX 952-471-9160
BUILDING PERMIT APPLICATION
Building Permit Application Requirements:
Date Received 43�d y
1.
Application to be filled out & signed
Date Approved 3 30
2.
Mechanical Permit Application & Calculation filled out
Permit No. p -'
3.
Energy Calculations filled out
4.
Furnish a Certificate of Survey - See Attached
S.
Furnish 3 sets of Construction Plans
Fees To Be Charged:
a) 1 set for City files
Permit
b)1 set for builder to use on site
State Surcharge , oy
c)1 set for City Building Inspector
Plan Review
Construction Plans should include:
SAC Charge
1.
First floor plan __-
Availability Chrg
2.
Footings foundation plan
3.
Elevations of all sides
TOTAL
4.
Wall sections & cross sections
5.
Details - stairs & any special connections
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
THE APPLICANT IS (CIRCLE ONE) ON
_ ,,OWNER OR TRACT
C`11 �Gd
JOB SITE ADDRESS _ hXN-C \ q-00A
NAME OF OWNER . S&1`fl HOME PHONE63-479-3232- WORK PHONE
MAILING ADDRESS �- CITY ZIP
CONTRACTOR i'er-eLh2Q 'U PHONE (OSI•atay•� �� MOBILE PHONE
MAILING ADDRESS jaati Co m�u 1'�,d.C,WA-.A CITY�'�d�V►I1'C� f11t� ZIP SSi�3
STATE LICENSE NO. gc013091�3
ARCHITECTIENGINEER PHONE
MAILING ADDRESS
CITY
NAME REGISTRATION NO.
ZIP
TYPE OF WORK: NEW ADDITION ACCESSORY STRUCTURE MOVE DEMO
REMODEUALTERATION RENOVATE LAND ALTERATION
PROPOSED WORK (Describe In Detail) C- p I CA!;tc,,Ar)Lo -'A —90-jf i a -Z�� LL)
ZONING DISTRICT
STORIES SQ. FEET OR EACH FLOOR NO. OF BEDROOMS GARAGE STALLS
ATTACHED OR DETACHED BLDG. SIZE: LENGTH WIDTH HEIGHT
ESTIMATED CONSTRUCTION VALUATION (excluding land) $ 3. 1 Lo 1 I
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BUILDING PERMIT APPLICATION
PAGE 2
HARDCOVER CALCULATION WORKSHEET
A. House X = S.F.
Length width
X = S.F.
B. Garage X = S.F.
C. Driveway X = S.F.
X = S.F.
D. Sidewalk X = S.F.
X = S.F.
E. Patio/Deck X = S.F.
F. Other X = S.F.
1. TOTAL HARDCOVER S.F.
2. TOTAL PROPERTY AREA S.F.
1 DIVIDED BY 2 X 100 = %
I hereby apply for a building permit and I acknowledge that the Information above Is complete and accurate; that the work will be In confonnance
with the ordinances and codes of the City and with the State Building Code; that I understand this is not a permit and work Is not to start without
a permit; and that the work will be In acc ance with the a roved plan.
APPLICANT'S SIGNATURE DATE ,'7 iY1GUid�
INSPECTION REQUIRED: WORK REQUIRING SEPARATE PERMITS:
Footing before a pour Plumbing
Framing rough -in Mechanical
Insulation Well
Wallboard before taping Grading & filling
FINAL before occupancy Sewer
Water
WORK BEYOND OR WITHOUT A REQUIRED
INSPECTION WILL BE SUBJECT TO PENALTY Electrical from State
24 HOUR NOTICE REQUIRED CALL 952-249-4600
ZONING CERTIFICATE
I do hereby certify to the Orono Building Official that the following described work has been reviewed for
compliance with the Zoning Requirements of the City of Spring Park and will be approved for construction upon
approval of the construction plans by the Building Official.
Name Date
Date
Fnrm Nn. 259
VaI1tatinn $3461
Election Systems and Software 1-800-800-8225
Perlai t $97.25
State 2.00��
Yota7....$.99.�25� ........ .
#e of Minnesota, �J ty.... of ...Sari ng ,Park ..........
County of .... Hennepi.n ............ Office of . ,g`i),Id n.g Inspector
Nuffbing V
IN CONSIDERATION OF The statements and representations made by ......................
Renewal By Andersen
....................................................................................................
in application therefor duly filed in this office, which application is hereby made a part hereof, PERMISSION IS HEREBY
GRANTEI} To said .... Renewal By cand�rsen.................................................... as owner
to .. re.al.ace.-A idaw .and. Pati.o..d4or. Per. a.PPl 11Gati.w1 ...........a building described as follows: kind of construction
(build, erect, install, add to, alter, repair, move, wreck, as the case may be)
....................................................................................................
front or 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 ................ ; plat or addition ................
4317 Channel Road 19 117-23-12-0033
..............................................................................................
which tract is of the size and area specified in said application.
This permit is granted upon the express conditions that said owner and h i s... contractors, agents, workers and
employees, shall comply in all respects with the ordinances of the .... C 7 t ;1............ of ..S p r i.n q .Park . , ... , . ;
that it does not cover the use of public property, such as streets, sidewalks, alleys, etc., for which special permits must
be secured; and that it does not cover the following:None of the ; of 1 owi rig
.........
(Electrical work, plumbing, heating, plastering, etc., if such there be.)
for which special permits must be secured.
Given under the hand of the .. 6:j.i1 d i n g. Inspector of said .... , C i ty ........ and its corporate seal and
attested by its ...... Cl Ark, , , , .. , , ... , this .. 30th................. day of . March........... , , year.2004 ....
Attest:
William D. Weeks ....................
Clerk
Lyle 0�1an.................................
BiAldina Inspector
One Hour Heating&AC
AlW0Y5 fi00..0 You--
po-f -/(--
SfO n..,j'7 (3 a, V t rn U
049J82043782
$ 00.490
08/14/2008
Mailed From 56301
US POSTAGE
CITY OF,
HEATING TEST RECORD
PERMIT NO.�_
NNER
)DRESS
STALLED BY
?ATING CONTRACTOR
` -.GAS DESIGNED UNIT
WE n
DDEL
TRIAL �rr�
ATED INPUT 9 V/C-C6
TEST
4NIFOLD PRESSURE PERCENT CO2
PUT CFH \ PERCENT 02 �0
rACK TEMP PERCENT/PPMCO
MIT SETTING !J PERCENT EFF "vf
ATE TESTED �� 0
WE OF LICENSED TESTER
'TY LICENSE #
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