Permits - Permit# 10-02D - 4341 Channel Road - 1/1/2010INSPECTION RECORD
PERMIT NUMBER o — o
Location c J D
Type of project #a1se- 5L SJ { ae2w
Permission isppreby granted to
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 City of_I
and to the Statues of the State ofdM nesota 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.
NOTICE
This card and reviewed construction plans must be posted near electrical
service cabinet prior to rough -in inspections and maintained until all
inspections have been approved. On buildings and additions where no
service cabinet is available, card and plans shall be placed near main
entrance. NO INSPECTION will be performed if card and plans are not
available to inspector. REINSPECTION FEE WILL BE CHARGED.
Do not occupy until all final inspections have been completed.
DATE C^4_140
BUILDING INSPECTIONS
Note: Penult holder Is responsible to call for these Inspections.
Required Inspections are circled
Date Inspector
(?�Agrwwis daf
Framing
oral
MECHANICAL & PLUMBING INSPECTIONS
Date Inspector
Plumbing Rough -In
Plumbing Final —
Heating Rough -In _
GAS LINE —
Heating Final
Fireplace Rough -In
Permit expires when building and work is not commenced within
180 days or If building and work Is suspended, abandoned or not GAS LINE
Inspected for 180 days.
CALL FOR ALL INSPECTIONS
24 HOURS IN ADVANCE
8:00 A.M. to 4:30 P.M.
Monday thru Friday 9S2-442-7S20
Non -Metro 1-888-446-1801
Fireplace Final
Electrical Rough -In
Electrical Final
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CITY OF SPRING PARK
4349 Warren Avenue Spring Park, MN 55384
Phone (952) 471-9051 Fax (952) 471-9160
BUILDING PERMIT
Noise Ordinance In Effect:
t rn c
C\ X
3 Z
O
Monday - Friday before 7 a.m.
and after 10 p.m.
Weekends/Holidays before 7
a.m. and after 8 p.m.
DATE 7- Z ?_ —1
SITE ADDRESS , PID
OWNER Name / Address / city / State / zip
,.
CONTACT NAME - PHONE - EMAIL - FAX
ARCHITECT If Required) Name / Address / City/ State / Zi / Phone
CONTRACTOR Name / Address / City/ State / Zi / Phone
CONTACT NAME - PHONE - EMAIL - FAX
CONTRACTOR LICENSE #
TYPE OF WORK
❑ New Home
❑ Deck
❑ Re -Roof
❑ Addition
❑ Fence Height:
❑ Re -Side
❑ Commercial AlResidential
EST. ALUATION OF WORK
❑ Remodel
❑ Pool
❑ Ret. Wall Height:
❑ Finish Basement
❑ Stucco Demo I
❑ Window Replacement
$
Building Height: Feet
❑ Accessory Structure
10 Stucco
ther:
# of Stories:
SCOPE OF WORK:
Use of Building:
Signature of this application by the legal property owner or a licensed contractor, as the owners representative is required and authorizes the City Zoning Administrator or designee and the City Building Official 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 and corect to the best
of my knowledge. I further agree that all work performed will be in accordance with approved plans, spedfications and conditions and to abide by all ordinances of the City 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 is not commenced with 180 days from date of permit
issued, or if building and work is suspended, abandoned or not inspected for 180 days. Work beyond or without a permit or inspection will be subject to a penalty.
Call MNSPECT for inspections at (952) 442-7520. (24 Hour Notice) 8:00 a.m. - 4:30 p.m.
SIGNATURE OF APPLICANT: DATE:
PRINTED NAME: DATE:
LEGAL DESCRIPTION: Lot Block Addition Zoning
Valuation of Permit: $ za
I Lot Area:
OCCUR TYPE: CONST. TYPE: CODE: 2 BLDG SPRINKLED Yes /
SETBACKS: REQUIRED (ft)
ACTUAL (ft)
Permit Fee:$
Front (ROW)
Plan Check Fee:$
Rear
State Surcharge:$
Side
Site Insp. Fee:$
Side
SE/WA Fee:$
Corner
S.E.0 Fee:$
Lakeshore
SAC Charge:$
Wetland
WAC Charge:$
Other
Sewer Hook -Up:$
Water Hook -Up:$
Paid Receipt No.
Water Meter:$ _
Other:$-"75
Date By
TOTAL DUE: $ 2?l�_7lf
BUILDING APPROVAL BY: DATE: -
TIME: 6
CITY APPROVAL BY: DATE:
TIME:
c/�F
Plan Review Comment Sheet
#863
Applicant: Robert Keskitalo Project: demo house Valuation: $ �P,S4D.C3C�
Permit #:10-02D Number of Days
Address: 4341Channel Rd. Municipality: Spring Park
Q
Date Issued: -cam. — YQ Inspector Issued•
Date & Comments
07/12/10 received application tm
07/22/10 per Nick — spoke with contractor checklist will be sent in, need plans showing building on
lot, need valuation, need report on asbestos
0727T /10 per Nick — spoke with contractor: checklist sent in later this week
1, 4U
iC
CITY FILE COPY
READ ALL ATTACHED MATERIALS!
NO OCCUPANCY OR USE ALLOWED
UNTIL FINAL INSPECTION AND APPROVAL
CALL BUILDING INSPECTOR 952-442-7520
OR A FEE MAY BE CHARGED
EVERY PERSON PERFORMING WORK FOR
WHICH THE CODE IS APPLICABLE SHALL
COMPLY WITH THE CODE.
IT IS THE RESPONSIBILITY OF
THE CONTRACTOR
TO CALL GOPHER STATE ONE CALL
651-454-0002,
OR 811 BEFORE BEGINNING
EXCAVATION
REVIEWED
SUBJECT TO COMPLIANCE
WITH CODES AND FIELD INSPECTION
DURING CONSTRU TI N `l
BY DATE
LOT LINES
PROPERTY LINES MUST BE STAKED IN
ORDER TO VERIFY SETBACKS TO LOT
LINES - IF NOT STAKED MUST PROVIDE
SURVEY.
CONTROL EROSION OF BARE SOIL AREAS SO
THAT SILTATION DOES NOT OCCUR INTO
STREET OR NEIGHBORING PROPERTIES UNTIL
LANDSCAPING AND TURF ESTABLISHMENT
ARE COMPLETE.
MUST POST ADDRESS ON
CONSTRUCTION SITE
VISIBLE FROM ROAD
FOR ALL INSPECTIONS
CALL (952) 442-7520
24 HOURS IN ADVANCE AND GIVE
PERMIT NUMBER 1 0-0;) 0
PUG-06-2010 14:49 BOLLIG AND SONS INC 9529389615 P.01/02
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CHECKLIST FOR DEMOLITION PERMIT
7- e -/0
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Project Name: TiK1'
��' Date:
Address.
U.k.0 leSa. City: r (% �c-
Owner's Name: �
I�tf4' Telephone Number:
Contractor's Name: � 0�-f Telephone Number: c? 3e W 4
Detaile explanation of work to be perfo ed:
,U. 9 CCL41*1r' `
_11 / r l.. e% A iJ Ash
Has theTllowing been provided or completed
No NIA
❑ Completed permit application submitted to the Municipality.
s Cap✓- C=C_7f f�
Two sets of site plans verifying the location and size of structure(s) being
demolished.
❑ Two sets of plans showing area of interior demo work.
Written verification and/or site plan identifying the type of pedestrian SL ' (i
protection being provided. Describe type, location and height of �-
fencing to be used.
Have all utilities been properly terminated.
Has a "Notification of Intent to Perform a Demolition" (not required for
single family dwellings) been submitted to the Minnesota Pollution
Control Agency.
❑ Have all wells been properly abandoned in accordance with StateG/i
H p 9 Health Department regulations.
❑ t Septic tanks pumped and removed.
e-
tWX 0 ❑ Written description of building demolition metho provQV
❑ ❑ Are there any underground storage tanks to be removed.
❑ ❑ Performance bond, letter of credit, escrow or securities provided
in accordance with the Municipality policy.
❑ Have all hazardous materials been removed and disposed of in
rdance wi h the Minnesota Pollution Control Agency.
Bc>JCA,*`
Signed: Date:
Septembe , 2007 Demolition
Page 2 of 2
Ili
Date Received
, _ at City Hall:
it
Demolition Property Address
Type Of Structure
Application For Demolition Permit Permit #: 10 - D
City of Spring Park, Minnesota
Telephone No.:
.,J -I, A.tC-
�_13 q
Fee: S40
U O
Approx Date To Begin: SG t s - O Estimated Completion Date: . /o� - ZO t
Utilities On Site: Check (✓) all that apply Sewer ✓ Water I/ Electricy
Cable Gas :�V 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 V 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 Pub 'c Works Department.
Is There a Water Well On Site? .................................... Yes No
Is There An Underground Fuel Tank? .......................... Yes No
Demolition Contractor: e, l . SUS Telephone No. C S 2, - 7.3 8 `� 3
Address: ��O ( o Q' CL
Liability Insurance Co.
Policy No:
Policy Period From:
To:
Telephone No.
Coverage And Limits:
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 the permit is a trKand correct statement of my intentions.
Signed By Applicant: `� �Date: :�,_ G — t1d
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
AH, 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 this application are complete, true and correct.
Applicant's Signature
Owner's Signature
Approved By:
Page 2 of 2
-JUL-08-2010 08:32 BOLLIG AND SONS INC
rromA,I I ur arniuu rnnn
9529389615 P.03
Permit Submittal Checklist: Demolition Permits
Permits are required for all building structures and/or interior building demolition worts. The permit fee
is based on valuation and must be submitted to the building inspection department for review.
• If a new structure will be built immediately following the demolition of the old structure, and
they are applying for the permits at the same time, then two permits are issued but the
valuation of the demolition work should be Included in the valuation of the new permit.
• If a new structure will be built sometime in the future, and is not applied for at the same time,
then two permits will eventually be issued. Therefore the permits will be issued separately,
one for the demolition and then one for the new construction permit, after they are reviewed.
It is the responsibility of the owner and/or contractor to comply with the requirements and rules of all
authorities and government agencies having jurisdiction. The permittee shall be responsible for
contacting all of the proper State, County and Local authorities prior to the demolition commencing.
All asbestos and other prohibited materials shall be removed and disposed of in accordance with the
rules and regulations established by the Minnesota Pollution Control Agency. The Department of
Natural Resources, County Environmental Services Department, County Watershed, City Utilities and
Public Works Directors are examples of agencies and/or authorities that may be involved in any given
project and a demolition permit issued by the Building Inspections Department shall not be construed
as permission to proceed without approval from all appropriate agencies.
Submittal Requirements:
❑ Application
Checklist for Demolition Permit with appropriate requested information attached
Required Inspections:
Prior to demolition the following items must be checked and remain in place throughout the
duration of the project:
❑ Traffic control
❑ Pedestrian protection
[Silt fence — dust control
❑ Owner/contractor must provide verification of proper clean-up and disposal of
contaminated soils, and all abatement issues, and disconnects
(see permit packet for requested documents)
❑ After the demolition project has taken place the following Items must be checked during the
final inspection:
❑ site properly cleaned up and appropriately graded
❑ Street cleaning
If you have any questions regarding the classification, removal, transport, disposal, or any questions
regarding asbestos rules, regulations, or standards, please feel free to contact the MPCA asbestos
team at the following numbers:
(651) 296-6300
(800) 657-3864
Information is also available at the MPCA website: http://www.oca.state.mn.0
September 14, 2007 Demolition
Page 1 of 2
TOTAL P.03
OP ID , i
AC ORD CERTIFICATE OF LIABILITY INSURANCE ID &
DATE ( MMIDD/YYYY)
E( 06 10
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
RJF Agencies, Inc. Plymouth
7225 Northland Dr N #300
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Minneapolis MN 55428
Phone : 763 - 74 6 - 8000
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: Indiana Insurance
22659
INSURER B: Travelers Insurance Co
25658
Bollig & Sons Inc
Linda Eckard
INSURERC:
INSURERD:
11401 Count Rd 3
Hopkins MN �5343
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN
LTR
NSR
TYPE OF INSURANCE
POLICY NUMBER
E
DATE MMIDD/YY
POLICY EXPIRATION
DATE MM/DDIYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F OCCUR
X Blkt Addl Inod
CBP2715586
02/28/10
02/28/11
EACH OCCURRENCE
$ 1,000,000
PREMISES(Eaoccurence)
$ 300,000
MED EXP (Any one person)
$ 15,000
PERSONAL BADVINJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2, 000, 000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X JEa 7 LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
A
AUTOMOBILE
LABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
BA2715581
02/28/10
02/28/11
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
R
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
_r
GARAGE LABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
AUTO ONLY: AGG
$
$
A
EXCESS/UMBRELLA LABILITY
X OCCUR CLAIMS MADE
DEDUCTIBLE
X RETENTION $ O
CU8754517
02/28/10
02/28/11
EACH OCCURRENCE
$ 4,000,000
AGGREGATE
s4,000,000
$
$
A
WORKERS COMPENSATION AND
EMPLOYERS' LABILITY
ANY PROPRIETOW/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
I1 Yes, describe under
SPECIAL PROVISIONS below
WC2715582
02/28/10
02/28/11
X TORY LIMITS ER
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYEE1
$ 500,000
E.L. DISEASE - POLICY LIMIT
$ 5 00 , 0 0 0
B
OTHER
Lease/Rented Equip
QTT6602872C804TIL09
02/28/10
02/28/11
Per Item $250,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
CITY OF SPRING PARR
4349 WARREN AVE
SPRING PARR MN 55384
.�nnn ——nn4moi
CITOSPR SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATIOII
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
RD CORPORATION 1999