Permits - Permit# 22SP-00047 - 4216 West Arm Drive - 11/2/2022 City of Spring Park Gas Line Only (Residential)
4349 Warren Ave, Spring Park, MN 55384
F
La PARK 22SP-00047
Ga e 9Vinneton a (952)471-9051 (952)471-9160
For Inspections: (952) 442-7520
Date Issued: 11/02/2022 Property Owner: Jerry Wiens
Expiration Date: 05/01/2023 Mailing Address: 4216 West Arm Drive
Job Site Address: 4216 West Arm Drive, Spring Park, MN
55384 Spring Park, MN 55384
Category: Residential Miscellaneous Phone:
Permit Type: Gas Line Only(Residential) Email:
Valuation:
Description of Work:
Install gas fireplace and gas line
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
11/02/2022
MUST BE POSTED ON JOB SITE
*#�)a
INSPECTION CARD
City of Spring Park
SPRING PARK
On Gale 914innetonkp 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-00047 PERMIT TYPE: (Residential) ISSUED DATE: 11/02/2022 EXPIRATION DATE: 05/01/2023
PROJECT ADDRESS: 4216 West Arm Drive,Spring Park,MN 55384 PARCEL NO.:
OWNER: Jerry Wiens CONTRACTOR: CONTRACTOR PHONE:
DESCRIPTION OF WORK: Install gas fireplace and gas line
CONSTRUCTION TYPE: OCCUPANT LOAD:
DATE DATE
INSPECTION INSP PASSED COMMENTS INSPECTION INSP PASSED COMMENTS
Mechanical Rough-In Air/Hydrostatic Test
Reports Imechanical Final
Fire Approval: Date: Engineering Date:
Approval:
PW Approval: Date: Other( ): Date:
To request an inspection:(952)442-7520
Paae 1 of 1
CITY OF SPRING PARK PAGE 1 BUILDING PERMIT
4349 Warren Avenue &0se-4-00"
Spring Park, MN 55384 ❑ Handout Given
Routed to MNSPECT
Phone: 952-471-9051 Fax: 952-471-9160 ❑ Lead Handout Given
SITE ADDRESS: 4216 WEST ARM DRIVE PID:
1)Was the home constructed before 1978?(YES❑,continue with line 2, NO ❑continue without completing EPA Section)
2)Will the work disturb?6 sq ft of interior painted surfaces or 220 sip ft of exterior painted surfaces?(YES c go to line 4, NO c line 3)
- 3)Are there any windows being replaced?(YES❑,go to line 4, NO o continue without completing EPA Section)
4)Has this home been Certified Lead Free?(YES❑,you MUST Attach Certification Information, NO o complete line 5)
5)EPA Contractor Certification Number: NAT- (applies to contractor only)
• PROPERTYOWNER: JERRY WIENS Address: SAME AS SITE
City: State: Zip: Email:
•• Contact Name: Phone: 239.777.0704
• CONTRACTOR: Fireside Hearth & Home Address: 2700 Fairview Ave N
city: ROSEVILLE StateMN zip: 11 Phone: 651-633-2561 Fax:
Contractor License No: RG,662656, MR662572 Contact Name: STUART Phone:
Email: ROSEVILLE BUILDER OPS HNICORP.COM
ARCHITECT: Address:
City: State: Zip: Phone: Fax:
• Email: Contact Name: Phone:
TYPE OF WORK: ❑New Construction ❑Deck ❑Re-Roof
❑Commercial Residential ❑Change of Use ❑Pool # ❑Re-Side
EST.VALUATION OF WORK ❑Finish Basement ❑Retaining Wall ❑Fence
$ 6681.00 ❑Remodel ❑Porch ❑Shed
Square feet: ❑Addition ❑Demolition ❑Window/Door Replacement
In Garage-Attached/Detach ❑Plumbing-provide detail on page 2 #being replaced
�• Detailed Description of Work: I❑Accessory Structure Mechanical-provide detail on Page 2 ❑Misc Other
INSTALL GAS FIREPLACE & GAS LINE
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 inspections,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 at work performed wig be in accordance with approved plans.specifications and conditions and to abide by all 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
rs 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.mm..and after 10 p.m.Weekends/Holidays before 7 a.m.and after 8 p.m.
�G SIGNATURE OF APPLICANT: Cli/tt— 9z"6 DATE: 10/31/22
PRINTED NAME: Stijart SpIseth This is the signature of: ❑ Owner or ❑Owner's Representative
OCCUP.TYPE: CONST.TYPE: CODE: BLDG SPRINKLED Yes/No
VALUATION:$
Permit Fee: $ 50 WAC Charge: $
Plan Review Fee: $ Sewer&Water Hook-Up: $
State Surcharge: $ 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. $
zo License Check($5)/Lead Check($5) $ TOTAL DUE: $
W SUB-TOTAL $
N 'NOTE: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:
LL
0
Building Approval By: DATE:
Printed Building Approval By: ❑ License Verification ❑ Lead Verification-Checked By:
City Approval tBcyr:� DATE
: 1 0�
Paid: �� . v v Date: ( a� Receipt No.g "71 By:
CITY OF SPRING PARK %6 MECHANICAL PERMIT
❑ PLUMBING PERMIT
PAGE 2 FOR PERMIT ISSUANCE
PAGE 1 and PAGE 2 should be complete
MECHANICAL INFORMATION
Mechanical Contractor: Fireside Hearth & Home Address: 2700 Fairview AveN
city: ROSEVILLE State: MN Zip: Phone: 651-633-2561 Fax:
State Bond No: M B662572 Contact Name: STUART
Email: ROSEVILLE BUILDER OPS HNICORP.COM lContact Phone:
Detailed Description of Work:
INSTALL GAS FIREPLACE & GAS LINE
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 Fumace
Air Conditioning System Bath Fan 1 Fireplace
Air Exchanger Grill Unit Heater
1 Fireplace Water Heater
Unit Heater Grill
In Floor Heat Dryer
Gas Log Stove
Office Use Only:
❑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: $
INFORMATIONPLUMBING
Plumbing Contractor: Address:
Ci : State: Zip: Phone: Fax:
Plumbers License No: State 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 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: $
❑Other Total Plumbing Permit: $
Payment Confirmation
Payer Information:
Payment Made By: CHRISTA WEGWART
Payment Made For: STUART SELSETH
Email: ROSEVILLE_BUILDER_OPS@HNICORP.COM
Permit Address: 4216 WEST ARM DRIV
Address: 2700, FAIRVIEW AVENUE N
ROSEVILLE, MN 55113
Payment Description: Permits
Payment Date: 11/1/2022 1:01:39 PM
Business Name Payment Payment Confirmation Amount Convenience Total
Method Account Number Fee
City of Spring Park MC ****4616 86007136 $51.00 $2.25 $53.25
(Permits)
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RECEIPT
City of Spring Park
4349 Warren Ave, Spring Park, MN 55384
(952)471-9051
SPRING PARK
22SP-00047 I Gas Line Only(Residential) On Lake Winnetonka
Receipt Number:81
Payment Amount: $51.00 November 1,2022
Transaction Method Payer Cashier Reference Number
Credit Card Fireside Hearth and Home Jamie Hoffman 86007136
Comments
Assessed Fee Items
Fee items being paid by this payment
Date Fee Item Account Code Assessed Amount Paid Balance Due
11/01/22 State Surcharge(Fixed) $1.00 $1.00 $0.00
11/01/22 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
4216 West Arm Drive Jerry Wiens 4216 West Arm Drive
Spring Park, MN 55384 Spring Park, MN 55384
Description of Work
Install gas fireplace and gas line