Fillable 2021 Application for Residential Building Permit (City of Burnsville)

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2021 Application for Residential Building Permit (City of Burnsville)

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The 2021 Application for Residential Building Permit (City of Burnsville) form is 2 pages long and contains:

  • 1 signature
  • 24 check-boxes
  • 47 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Burnsville

BROWSE CITY OF BURNSVILLE (MN) FORMS

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Date
Site Address
Owner: Name
Address
City St.
Zip Tel.
Email: _____________________________________
CONTRACTORS
Bldr: Name Address
City St. Zip Tel.
State License Number
Email: ________________________________________________________________________________ REQUIRED
Lead Certificate #____________________________ (Include copy of Certification)
Plum: Name______________________________________ __________ Phone #____________________________________
Htg: Name________________________________________________ Phone #_____________________________________
Elect: Name Phone #____________________________________
S & W Name Phone #____________________________________
Type of Const: New Addition Remodel Basement Finish Deck
Screen / 3 season Porch Swimming Pool Retaining Wall Accessory Building
**Plans/Drawings are required for any of the above projects.
Plan reviews may take up to 2 weeks. We will contact you with the fee amount when approved**
Valuation of Construction $
DETAILED DESCRIPTION OF WORK:
SIGNATURE IS REQUIRED – SEE PAGE 2
FOR CITY USE ONLY
Permit No.
Permit Fee $
Plan Check Fee $
Lead Cert. Fee $_______________
State Surcharge $
TOTAL FEES: $
2021 Application for Residential Building Permit
Single Family Multi-Family/Twin Home Town Home Condo Manufactured Home
Specify the square footage of the project only:
Dimensions: x = sq. ft. Crawl Spaces
x = sq. ft. Basement
x = sq. ft. 1
st
Floor
x = sq. ft. 2
nd
Floor
x = sq. ft. 3
rd
Floor
TOTAL SQ. FT.
Garage / Shed: x ■■■► Attached Detached Tuck under
Check Appropriate Box if Project is exempt for Lead Certification:
The applicant is not a Minnesota licensed residential Contractor, residential remodeler or roofer.
The building was constructed after 1978.
The structure is not residential housing or a child occupied facility.
The renovation will not disrupt 6 sq. ft or more of painted surface per room for interior activities, or 20 sq. ft or more of
painted surface for exterior activities and does not involve windows.
Other (Please explain) _____________________________________________________________________________
I hereby certify that the above information is correct and agree to comply with Burnsville Ordinances and State of Minnesota laws
regulating building Construction.
Any construction for which a building permit has been issued for exterior work shall be completed and
ready for occupancy according to the approved plans and specifications within one hundred eighty (180)
days following issuance of said permit, unless within that time an extension is granted by the building
official. (Ord. 1395, 8-16-2016
Signature Owner Contractor
100 Civic Center Parkway (952) 895-4444
Burnsville, MN 55337-3817 FAX: (952) 895-4512
Email: permits@burnsvillemn.gov
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2021 Application for Residential Building Permit (City of Burnsville)

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Completed 17 January 2021

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