Permits - Permit# 19-02 - 2400 Interlachen Road - 1/23/2019CITY 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: 2400 Interiachen Rd Unit 317
PID:
1) Was the home constructed before 1978? (YES a, continue with line
2, NO m continue without completing EPA Section)
2) Will the work disturb a6 sq ft of interior painted surfaces or 2!20 sq ft of exterior painted surfaces? (YES a go to line 4, NO ❑ line 3)
3) Are there any windows being replaced? (YES o, 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 ❑ complete line 5)
3) EPA Contractor Certification Number. NAT -
(applies to contractor only)
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PROPERTY OWNER: Tami Johnson
Address: 2400 Interlachen Rd Unit 317
city. Spring Park State: MN zip: 55384
Email:
Contact Name:
Phone: 952-471-8185
CONTRACTOR: US Patio Systems
Address: 218 N River Ridge Circle
city: Burnsville State: MN Zip: 55337
Phone: 952-314-9885 Fax::-'-:_`"
Contractor License No: BC661813 PC708206
Contact Name: Wendy Rache Phone A52-314-9885
Email: wrache us of st ms.com
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ARCHITECT:
Address:
City: Stale: Zip:
Phone: Fax:
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Email:
Contact Name -^ _ Phone:
TYPE OF WORK: o New Construction
m Deck ❑ Re -Roof
n Commercial ttesidentia[ ❑Change of Use
❑Pool a Re -Side
EST. VALUATION OF WORK ❑Finish Basement
o Reiftirnng Walt a Fence
$ 8746 X Remodel
❑ Porch a Shed
Square feet: ❑Addition =
❑ Demolition = ❑ Window/Door Replacement
o Garage-Attached/b8_$gh
;:&Plumbing-Vrovtde detail on Page 2 # being replaced
Detailed Description of Work: nAccessoFy. Structure ` o Mechanical -provide detai on Page 2 ❑ Misc Other
bath 1 - replace surround, vanity top and faucet -
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bath 2 - replace shower an valve surround vanil Eo
faucet
Signatwe of this appbcatJon by the legal propertlowier or -'a rcansed contractor, as VA ohiter's represerntath a. is required and authorizes the Zordng AdminhWstor ordesrgnee and the eu.1diry ofrcfal
or des)grtes io enter upon the property to perform needed Insp%tbns. Entrymay be m'tioirt prior
no5ce. I hereby acknoMedge that l tore read IIM appticatlen and state that a!1 Information is true and
correct to the bast of my k roMedge. (further agree that al woikperrormed xis_be in a:cordance with approved plans, speci'lcal1om and conaws and to abNe by a7 ordinances of the hlvnkpality
and the lags ofthe state of hd4vresota fegatang actions tahen'psaM tows - permit agree to
pay all plan reviarr [eas even ill choose not to proceed with the work. Permit expires Khert leork
rr
Is not commenced within 18o dais from da.a.of pt-fmA,'ar t(.wofg is suspended, abandoned, or not inspected for 1aO days. Work beyond the `cope of this permit, or work Kslhout a permit or inspectim,
WA be subject to a penalty.
Noise Ordinarice`lri Effedt_h10 AY - FRIDAY Yefre 7 a.m. and
after 10 p.m. Weekends/Holidays before 7 a.m. and after 8 p.m.
SIGNATURE OF APP4ICANT:MOVI
DATE:1/2111.9
PRINTED NAME:_ Wendy-Rache
his is the signature of: a Owner or ncOwner's Representative
OCCUP. TYPE: ` CONST. TYPE: CODE:
BLDG SPRINKLED Yes / No
VALUATION:
Permit Fee: $
WAC Charge: ^�
Plan Review Fee: $
Sewer & Water Hook -Up: $
State Surcharge: $
Seder & Water Disconnect: $
Site Inspection Fee: $
Water Meter $
S.E.C. Fee: $
Muni SEIWA Fee: $
investigation Fee / Other Fee: $
*2016 SAC Escrow. S2 b85
Copy Charge ($.25 per8.5 x11 page) $
Other. $
z0
License Check ($5) / Lead Check ($5) $
TOTAL DUE: $
W
SUB -TOTAL $
0
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Plumbing (from Page
9 Fee (fP9 2 ) $
'NOTE, Commercial plans will be submitted to the Met Council Environmental Svcs
Is
W
Mechanical Fee from Page 2 $
for SAC determination. Escrow payment will be required when permit issued. If
after Met Council revlew no SAC is determined, escrow will be refunded In full.
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Special Conditions/Required Setbacks:
LL
Building Approval By:
DATE:
Printed Building Approval By:
El License Verification O Lead Verification - Checked By:
City Approval By:
DATE:
Paid: Date: Receipt No.
By:
CITY OF SPRING PARK MECHANICAL PERMIT
Z] PLUMBING PERMIT
PAGE 2 FOR PERMIT ISSUANCE
PAGE i and PAGE 2 should be complete
INFORMATION
Mechanical Contractor: Address:
City: State: zip: Phone: Fax:
State Bond No:
lContact Name:
Email:
Contact Phone:
Detailed Description of Work:
Indicate type of project, fixtures, and Gas Lines you will be installing or replacing (include count for each type cjf,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 Lo_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: $
PLUMBING INFOWATioN
Plumbing Contractor: US Patio_S;-stems, .- Address: 218 N River Ridge Circle
CRY: Burnsville State: MN>. Zi--55337 Phone: 952-314-9885 Fax:
Plumbers License No: PC708206 = _
State Bond No: 7900440844
Contact Name: Wend
lContact Phone: 952-314-9885
Email: --- -
j� stems -barn
Detailed Descriliff6n of Worts:
bat 1 - re ace surround. va i op and faucet
bath 2 - replace shower pan, valve surround vanity top, faucet
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 1 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
2 Lavatory ash Basin Bathtub
Office Use Only:
❑ Replacement (one fixture only, no piping or vent changes)
Plumbing Permit Fee: $
Wddition/Remodel
State Surcharge $
❑ New Construction
Other: $
❑ Other
Total Plumbing Permit: $
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