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Permits - Permit# 212SP-00009 - 4434 West Arm Road - 6/27/2022
City of Spring Park Gas Line Only 4349 Warren Ave, Spring Park, MN 55384 (Residential PRING PARK 22SP-00009 n Lake9Ninnetonka (952)471-9051 Fax(952)471-9160 For Inspections: (952)442-7520 Date Issued: 06/24/2022 Property Owner: Dale Klein Expiration Date: 12/21/2022 Mailing Address: 4434 West Arm Road Job Site Address: 4434 West Arm Road, Spring Park, MN Spring Park, MN 55384 55384 Phone: Category: Residential Miscellaneous Email: Permit Type: Gas Line Only(Residential) Valuation: Description of Work: Gas line to unit heater Subdivision: Required Setbacks: Parcel ID: Filing: Lot: Actual Setbacks: Block: Total Sq Ft: Contractors: Fee Items Amount State Surcharge (Fixed) $ 1.00 Residential Gas Line Only Permit $ 50.00 Total Fees: $ 51.00 NOTICE Signature of Applicant/Date Building Department Signature/Date 06/27/2022 INSPECTION CARD *kzt- City of Spring Park SPRING PARK On Lake 911innetonKq 4349 Warren Ave, Spring Park, MN 55384 POST THIS CARD IN A SAFE CONSPICUOUS LOCATION.PLEASE DO NOT REMOVE THIS NOTICE UNTIL ALL REQUIRED INSPECTIONS ARE MADE AND SIGNED OFF BY THE APPROPRIATE AUTHORITY AND THE BUILDING IS APPROVED FOR OCCUPANCY.STAMPED APPROVED PLANS MUST BE AVAILABLE ON THE JOBSITE. Gas Line Only PERMIT NO.: 22SP-00009 PERMIT TYPE: (Residential) ISSUED DATE: 06/24/2022 EXPIRATION DATE: 12/21/2022 PROJECT ADDRESS: 4434 West Arm Road,Spring Park,MN 55384 PARCEL NO.: OWNER: Dale Klein CONTRACTOR: CONTRACTOR PHONE: DESCRIPTION OF WORK: Gas line to unit heater CONSTRUCTION TYPE: OCCUPANT LOAD: DATE DATE INSPECTION INSP PASSED COMMENTS INSPECTION INSP PASSED COMMENTS Mechanical Rough-In I Air/Hydrostatic Test Reports I Mechanical Final Fire Approval: Date: Fire Approval: Date: PW Approval: Date: Other( ): Date: To request an inspection:(952)442-7520 Page 1 of 1 CITY OF SPRING PARK PAGE 1 �BUILDING PERMIT 4349 Warren Avenue Spring Park, MN 55384 ❑ Handout Given Phone: 952-471-9051 Fax: 952-471-9160 ❑ Lead Handout Given Routed to MNSPECT SITE ADDRESS: 443,lf W Arm Rd PID: 1)Was the home constructed before 1978?(YES x,continue with line 2,NO ❑continue without completing EPA Section) 2)Will the work disturb>_6 sq ft of interior painted surfaces or z20 sq ft of exterior painted surfaces?(YES-1 go to line 4,NO R line 3) _ 3)Are there any windows being replaced?(YES❑,go to line 4,NO W continue without completing EPA Section) 4)Has this home been Certified Lead Free?(YES❑,you MUST Attach Certification Information,NO❑complete line 5) S)EPA Contractor Certification Number: NAT- (applies to contractor only) • PROPERTY OWNER: Dale Klein Address: 4434 W Arm Rd City:Spring Park State: MN Zip: 55384 Email: Contact Name: Phone: CONTRACTOR: Butch's Heating and Air LLC Address: 2217 Valley View Rd City: Shakopee State: MN Zip: 55379 Phone: 952-463-5213 Fax: Contractor License No: Contact Name: Eric La Tour Phone: 612-210-9969 Email: butchsheatingandair@yahoo.com ARCHITECT: Address: City: State: Zip: Phone: Fax: • Email: Contact Name: Phone: TYPE OF WORK: ❑New Construction c Deck ❑Pool ❑Re-Roof o Commercial x Residential ❑Change of Use ❑Retaining Wall ❑Porch ❑Re-Side EST.VALUATION OF WORK ❑Finish Basement o Demolition ❑Fence $ 850 ❑Remodel ❑Fire Sprinkler ❑Shed Square feet: ❑Addition ❑Fire Alarm ❑Window/Door Replacement ❑Garage-Attached/Detach o Plumbing-provide detail on Page 2 #being replaced Detailed Description of Work: ❑Accessory Structure Mechanical-provide detail on Page 2 ❑Misc Other Gas line to unit heater • 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 official or designee to enter upon the property to perform needed Inspectbns.Entry may be without prior notice.I hereby acknowledge that I have read this application and state 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 at 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 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.WeekendslHolidays before 7 a.m.and after 8 p.m. SIGNATURE OF APPLICANT: �cti DATE: 6/21/2022 PRINTED NAME: Eric La Tour This is the signature of: 9 Owner or c Owner's Representative OCCUP.TYPE: CONST.TYPE: CODE: BLDG SPRINKLED Yes/No VALUATION:$ Permit Fee: $ 5o .6-10 WAC Charge: $ Plan Review Fee: $ Sewer&Water Hook-Up: $ State Surcharge: $ TD Sewer&Water Disconnect: $ Site Inspection Fee: $ Water Meter. $ S.E.C. Fee: $ Muni SE/WA Fee: $ Investigation Fee/Other Fee: $ `2016 SAC Escrow: $2 485 >- Copy Charge($.25 per 8.5 x11 page) $ Other. $ OLiconco Check($5)/Load Chock($5) $ TOTAL DUE: $ W SUB-TOTAL $ 'NOTE:Commercial plans will be submitted to the Met Council Environmental Svcs M Plumbing Fee(from Page 2) $ for SAC determination. Escrow payment will be required when permit is issued. If ul Mechanical Fee from Page 2 $ after Met Council review no SAC is determined,escrow will be refunded In full. U LL Special Conditions/Required Setbacks: ILL O Building Approval By: DATE: Printed Building Approval B ❑ License Verification❑ Lead Verification-Checked By: City Approval B DATE: Paid: S�•W Date: �7 a3 Receipt No. By: ,L 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: Butch's Heating and Air LLC Address: 2217 Valley View Rd C : Shako ee State:MN Zip: 55379 Phone: 952-463-5213 Fax: State Bond No: MB740802 Contact Name: Eric La Tour Email: butchsheatingandair@yahoo.com lContact Phone: 612-210-9969 Detailed Description of Work: Gas line to future unit heater Indicate type of project,fixtures,and Gas Lines you will be installing or replacing (include count for each type of fixture): MECHANICAL FIXTURES GAS LINES Quantity Quantity Quantity Furnace Kitchen Fan Furnace 1 Unit heater gas line Air Conditioning System Bath Fan Fireplace Air Exchanger Grill Unit Heater Fireplace Water Heater Unit Heater Grill In Floor Heat Dryer Gas Lo-q Stove Office Use Only: ❑Replacement(one fixture only, no piping or vent changes) Mechanical Permit Fee: $ Z Addition/Remodel Gas Line Permit Fee: $ ❑New Construction State Surcharge: $ ❑Other Other. $ Total Mechanical Permit: $ PLUMBING INFORMATION Plumbing Contractor: Address: City: State: Zip: Phone: Fax: Plumbers License No: IState Bond No: Contact Name: I Contact Phone: Email: 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 Quantity Quantity Quantity 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 Water Closet(Toilet) Hose Bib Floor Drain Lavatory Wash Basin Bathtub Office Use Only: ❑ Replacement(one fixture only, no piping or vent changes) Plumbing Permit Fee: $ ❑Addition/Remodel State Surcharge $ ❑ New Construction Other: $ ❑ Other Total Plumbing Permit: $ . ACO CERTIFICATE OF LIABILITY INSURANCE DATE /8/202/YYYY) as/2o22 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CON 1AG1 NAME: David P85S Flagship Insurance Services,Inc PHONE 6122325672 g p A/C No,Est: (A/C,No): 230 1st Ave E ADDRESS: dpassinsurance@gmail.com INSURER(S)AFFORDING COVERAGE NAIC# Shakopee MN 55379 INSURER A: WEST BEND MUT INS CO 15350 INSURED INSURER B: SUPERIOR INS CO 12220 Butch's Heating and Air,LLC INSURER C: 2217 Valley View Rd INSURER D: INSURER E: Shakopee MN 55379-9435 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NS TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx]OCCUR PREMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 A A435692 04/09/2022 04/09/2023 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO-ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: I $ AUTOMOBILE LIABILITY $ (Ea accident) 1,000,0()0 X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED A435692 04/09/2022 04/09/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED AUTOS ONLY AUTOS ONLY (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ 5 WORKERS COMPENSATION - AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B EXCLUDED? N/'�` 100473.804 6/29/2021 6/29/2023Mdatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 �DFa`nCER/MEMBER yes,describe under ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Mechanical Bond 2381812 04/09/2022 04/09/2024 $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Spring Park THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 4349 Warren Ave ACCORDANCE WITH THE POLICY PROVISIONS. Spring Park, MN 55384 AUTHORIZED REPRESENTATIVE David C,Pays ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD RECEIPT City of Spring Park 4349 Warren Ave, Spring Park, MN 55384 (952)471-9051 SPRING PARK 22SP-00009 I Gas Line Only(Residential) On Lake Minnetonka Receipt Number:22 Payment Amount: $51.00 June 24, 2022 Transaction Method Payer Cashier Reference Number Check Butch's Heating&Air Jamie Hoffman 5093 Comments Assessed Fee Items Fee items being paid by this payment Date Fee Item Account Code Assessed Amount Paid Balance Due 06/23/22 State Surcharge(Fixed) $1.00 $1.00 $0.00 06/23/22 Residential Gas Line Only Permit $50.00 $50.00 $0.00 Totals. $51.00 $51.00 Previous Payments $0.00 Remaining Balance Due $0.00 Permit Info Property Address Property Owner Property Owner Address Valuation 4434 West Arm Road Dale Klein 4434 West Arm Road Spring Park, MN 55384 Spring Park, MN 55384 Description of Work Gas line to unit heater