Permits - Permit# 22SP-00022 - 2433 Black Lake Road - 8/1/2022 City of Spring Park Mechanical Replacement -
Single Appliance (Residential)
4349 Warren Ave, Spring Park, MN 55384
FPRINPARK 22sP-00022
G
La a 96finneton a (952)471-9051 (952)471-9160
For Inspections: (952)442-7520
Date Issued: Property Owner: DEBBIE HOLINKA
Expiration Date: 01/23/2023 Mailing Address: 2433 BLACK LAKE RD
Job Site Address: 2433 BLACK LAKE ROAD, SPRING
PARK, MN 55384 SPRING PARK, MN 55384
Category: Residential Miscellaneous Phone:
Permit Type: Mechanical Replacement-Single Email:
Appliance(Residential)
Valuation:
Description of Work:
Replace A/C
Subdivision: Required Setbacks:
Parcel ID: 1911723120019
Filing:
Lot: 14 Actual Setbacks:
Block:
Total Sq Ft:
Contractors: Fee Items Amount
Primary Peak Heating (952)401-1195 State Surcharge(Fixed) $ 1.00
Residential Mech./Pig. Replacement Permit $50.00
Total Fees: $ 51.00
NOTICE
Signature of Applicant/Date Building Department Signature/Date
08/01/2022
'y- City of Spring Park Mechanical Replacement -
Single Appliance (Residential)
4349 Warren Ave, Spring Park, MN 55384
FPRIMG PARK -9051 -9160 22SP-00022
Lake�Winneton a (952)471 (952)471
For Inspections: (952) 442-7520
Date Issued: 08/01/2022 Property Owner: DEBBIE HOLINKA
Expiration Date: 01/28/2023 Mailing Address: 2433 BLACK LAKE RD
Job Site Address: 2433 BLACK LAKE ROAD, SPRING
PARK, MN 55384 SPRING PARK, MN 55384
Category: Residential Miscellaneous Phone:
Permit Type: Mechanical Replacement-Single Email:
Appliance (Residential)
Valuation:
Description of Work:
Replace A/C
Subdivision: Required Setbacks:
Parcel ID: 1911723120019
Filing: I I F
Lot: 14 Actual Setbacks:
Block:
Total Sq Ft:
Contractors: Fee Items Amount
Primary Peak Heating (952)401-1195 State Surcharge(Fixed) $ 1.00
Residential Mech./Plg. Replacement Permit $ 50.00
Total Fees: $51.00
NOTICE
Signature of Applicant/Date Building Department Signature/Date
08/01/2022
MUST BE POSTED ON JOB SITE
INSPECTION CARD
City of Spring Park
SPRING PARK
On LakeMinnetonkq 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.
Mechanical
PERMIT NO.: 22SP-00022 PERMIT TYPE: Replacement- ISSUED DATE: 08/01/2022 EXPIRATION DATE: 01/28/2023
Single Appliance
(Residential)
1911723120
PROJECT ADDRESS: 2433 BLACK LAKE ROAD,SPRING PARK,MN 55384 PARCEL NO.: 019
OWNER: DEBBIE HOLINKA CONTRACTOR: Peak Heating CONTRACTOR PHONE: (952)401-1195
DESCRIPTION OF WORK: Replace A/C
CONSTRUCTION TYPE: OCCUPANT LOAD:
DATE DATE
INSPECTION INSP PASSED COMMENTS INSPECTION INSP PASSED COMMENTS
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
Routed to MNSPECT
Phone: 952-471-9051 Fax: 952-471-9160 ❑ Lead Handout Given
SITE ADDRESS:,Y 5-3 3�t cis- Lsk, Z PID:
1)Was the home constructed before 1978?(YES:_i,continue with line 2,NO continue without completing EPA Section)
2)Will the work disturb?6 sq ft of interior painted surfaces or 2?20 sq ft of exterior painted surfaces?(YES c go to line 4,NO❑line 3)
_ 3)Are there any windows being replaced?(YES❑,go to line 4,NO❑continue without completing EPA Section)
4)Has this home been Certified Lead Free?(YES❑,you MUST Attach Certification Information,NO❑complete line 5)
5)EPA Contractor Certification Number: NAT- (applies to contractor only)
• PROPERTY OWNER: (, �4; 4/I'A Address: 0/c,t/t Lek- 2
City: �rK State: ./fin Zip: � �`6`� Email:
ra Contact Name: Phone:
CONTRACTOR: Address:
City: State: Zip: Phone Fax:
Contractor License No: Contact Name: Phone: -
Email:
ARCHITECT: Address-
City. State: Zip: Phone: Fax:
• Email. Contact Name:, Phone:
TYPE OF WORK: New Construction ❑Deck � '�,�. ❑Pool ❑Re-Roof
o Commercial Residential =Change of Use u RetaInIng W It Porch ❑Re-Side
EST.VALUATION OF WORK =Finish Basement o Demoli6ni ll
` o Fence
Remodel ❑Fire Sprinkler ❑Shed
Square feet: =Addition ❑fire Alarm ❑Window/Door Replacement
p _Garage-Attached/D( Ili, Plumbing-prwide detail on Page 2 #being replaced
rr Detailed Descri lion of Work: _Acces iW cture eChaniC21 provide detail on Page 2 u Misc Other
•
• is;f16..::,:u:it�'I�li''
Signature of this application by the legal property owner a'a�lkensed iaitie clot,as the owners representative.:a required and authorizes the Zon,,ng Administrator or des.gnee and the Building ORO&
or designea to enter upon the property to perform needed inspections.Entry may be vfithcut prior notice.I hereby acknowledga that I have read this application and state that all information is true and
eorract to the best of my knowledge.I further agree that all workperformed,wN:beiln accomanea with approved plans,specifications and conditions and to abide by all orolnances of the Municipality
and the laws of the State of Minnesota regardng actions taken pursuant to th7s permit.I agree to pay all plan review fees even if I choose not to proceed with the work.Permit expires when work
rr is not commenced.vtthtl 180 days from dtlha:tif peatllt,;W.pri0fk sailapended.Vandcriec,or not Inspected for 160 days 'Mork beyond the scope of this permit or work without a permit or inspection.
• will be subject to a panaly.
Noise Ordinarillb In,Effect: O AY- 14 BeJkW7 a.m.and after 10 p.m.Weekends/Holidays before 7 a.m.and
dd7after 8 p.m.
SIGNATURE OF APPL ICAWT: DATE:
PRINTEl3 :, _ .. J ' .t f signature of: o Owner or er's Representative
' This is the si
OCCUP.-TYPE: f CONST.TYPE: CODE: BLDG SPRINKLED Yes/No
VALUATION:$;
Permit Fee: $ •A-/ ' WAC Charge: $
Plan Review Fee: $ Sewer&Water Hook-Up: $
State Surcharge: $ L Sewer&Water Disconnect: $
Site Inspection Fee: $ Water Meter: $
S.E.C.Fee: $ Muni SE/WA Fee: $
Investigation Fee/Other Fee: $ `2016 SAC Escrow: $2 485
r Copy Charge($.25 per8.5 x11 page) $ Other: $_ _.
z ticcnc e,Chcek($5)1 Lcad Check(S5)$ _ TOTAL DUE: $ ___
W SUB-TOTAL $
to
N07E:Commercial plans will be submitted to the Met Council Environmental Svcs
D Plumbing Fee(from Page 2) $ for SAC determination. Escrow payment will be required when permit is issued. If
w 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:
tL
O
Building Approval By: DATE:
Printed Building App val By: ❑ License Verification 17 Lead Verification-Checked By:
City Approval B . DATE: , t
Paid: 1. Date: �� Receipt No. l By:
CITY OF SPRING PARK ❑ MECHANICAL PERMIT PLUMBING PERMIT
PAGE 2 FOR PERMIT ISSUANCE
PAGE 1 and PAGE 2 should be complete
,�echanic al ContractrJr. C"
Address: U �"�� r
yt Zi : 3/ Phone! �1— S Fax:
rEm
.L�Uh U.SS�✓� State: ,
e Bond No: Contact Name: f
ail ea ,, L 0�La
Contact Phone:
Detailed Description of Work: /ctCe Z,—
Indicate type of project, fixtures,and Gas Lines you will be installing or replacing (include count for each type df fixture)
MECHANICAL FIXTURES GAS LINES
Quantity Quantity Quantity
Furnace Kitchen Fan Furnace
Air Conditioning System Bath Fan Fireplace
Air Exchanger Grill Unit Heater -
Fireplace Water Heater
Unit Heater __ Grill
In Floor Heat Dryer
Gas Log Stove
Oft Use Ont r
replacement(one fixture only, no piping or vent changes) Mechanical Permit Fee: $
!Addition/Remodel
Gas Line Permit Fee: $
New Construction - State Surcharge: $
Other Other: $
Total Mechanical Permit: $
PLUMBING INFORMATION
Plumbing Contractor: Address:
City: State: Phone: Fax:
Plumbers License No: State Bond No:
Contact Name 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
I i Gas i i Electric Dishwasher Rough4n Future Fixture
__Water Softener Clothes Washer Sump
Lawn Sprinkler System Ice Maker Line Water Pipinq 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: $
r: Other Total Plumbing Permit: $
RECEIPT
City of Spring Park •�"
4349 Warren Ave, Spring Park, MN 55384
(952)471-9051
SPRING PARK
22SP-00022 I Mechanical Replacement-Single Appliance (Residential) On Lake Minnetonka
Receipt Number:44
Payment Amount: $51.00 August 1,2022
Transaction Method Payer Cashier Reference Number
Check Peak Heating and Cooling Jamie Hoffman 008618
Comments
Assessed Fee Items
Fee items being paid by this payment
Date Fee Item Account Code Assessed Amount Paid Balance Due
07/27/22 State Surcharge(Fixed) $1.00 $1.00 $0.00
07/27/22 Residential Mech./Plg. Replacement 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
2433 BLACK LAKE ROAD DEBBIE HOLINKA 2433 BLACK LAKE RD
SPRING PARK, MN 55384 SPRING PARK, MN 55384
Description of Work
Replace A/C