Permits - Permit# 25SP-00041 - 2433 Black Lake Road - 7/1/2025-r' I City of Spring Park I Mechanical (Residential)
4349 Warren Ave, Spring Park, MN 55384
�^ 25SP-00041
PARK Phone:(952) 471-9051 Fax: (952) 471-9160
For Inspections: (952) 442-7520
Date Issued: 07/01/2025
Property Owner: PHILLIP ANTHONY & DEBRA LANE
Expiration Date: 12/28/2025
HOLINKA
Job Site Address: 2433 BLACK LAKE RD, SPRING
Mailing Address: 17 OAK LANE
PARK, MN 55384
Category: Residential Miscellaneous
SPRINGFIELD, MN 62712
Permit Type: Mechanical (Residential)
Phone: (309) 453-2115
Valuation:
Email: dlholinka@gmail.com
Description of Work:
Install gas fireplace with gas line & venting, heat & glo, 6kx-bl
Subdivision:
Required Setbacks:
Parcel ID: 19-117-23-12-0019
Filing:
Actual Setbacks:
Lot:
Block:
Total Sq Ft:
Contractors:
Fee Items
Amount
Primary HEARTH & HOME TECHNOLOGIES (651)
State Surcharge (Fixed)
$ 1.00
638-3321
Residential Mechanical Permit
$ 105.00
Total Fees:
$ 106.00
NOTICE
Signature of Applicant/Date
Building Department Signature/Date
07/01/2025
MUST BE POSTED ON JOB SITE
INSPECTION CARD
City of Spring Park
SPRING PARK
OnGake914innetonka 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.: 25SP-00041 PERMIT TYPE: (Residential) ISSUED DATE: 07/01/2025 EXPIRATION DATE: 12/28/2025
19-117-23-
PROJECT ADDRESS: 2433 BLACK LAKE RD, SPRING PARK, MN 55384 PARCEL NO.: 12-0019
PHILLIP ANTHONY & DEBRA LANE
OWNER: HOLINKA OWNER PHONE: (309) 453-2115
CONTRACTOR: HEARTH & HOME TECHNOLOGIES CONTRACTOR PHONE: (651) 638-3321
Fireside Hearth and Home - Doug
APPLICANT: Carlson APPLICANT PHONE: (651) 638-3329
DESCRIPTION OF WORK: Install gas fireplace with gas line & venting, heat & glo, 6kx-bl
CONSTRUCTION TYPE:
OCCUPANTLOAD:
DATE DATE
INSPECTION INSP PASSED COMMENTS INSPECTION INSP PASSED COMMENTS
Mechanical Rough -In Air/Hydrostatic Test
Reports Mechanical Final
Fire Approval:
PW Approval:
To request an inspection: (952) 442-7520
Date:
Date:
Engineering
Approval:
Other(
Date:
Date:
Page 1 of 1
CITY OF SPRING PARK
BUILDING PERMIT
4349 Warren Avenue
PAGE 1
D--551f'MC y i
Spring Park, MN 55384
❑ Handout Given
Routed to SAFEbuilt
Phone: 952-471-9051 Fax: 952-471-9160
❑ Lead Handout Given
SITE ADDRESS:2433 BLACK LAKE RD
PID:19-117-23-12-0019
1)
Was the home constructed before 1978? (YES [3, continue with line
2, NO i] continue without completing EPA Section)
2)
Will the work disturb >!6 sq ft of interior painted surfaces or >_20 sq ft of exterior painted surfaces? (YES ❑ 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 -
PROPERTY OWNER: P A HOLINKA & D L HOLINKA
Address:2433 BLACK LAKE RD
cit :SPRING PARK State:MN zip: 55384
Email:ianbigham@gmaiI.com
Contact Name:IAN BINGHAM
Phone:952-923-4248
CONTRACTOR: FIRESIDE HEARTH & HOME
Address:2700 FAIRVIEW AVE N
Citv:ROSEVILLE State: MN zip:55113
Phone:651-638-3329 Fax:
Contractor License No:MB662572
ContactName:DOUG CARLS('Rhone:651-638-3329
Email:ROSEVILLE_BUILDER OPS@HNICORP.COM
ARCHITECT:
Address:
City: State: MN zip:
Phone: Fax:
Email:
Contact Name: Phone:
TYPE OF WORK: []New Construction
❑Deck []Re -Roof
❑Commercial EIResidential ❑Change of Use
❑Pool ❑Re -Side
EST. VALUATION OF WORK ❑Finish Basement
❑Retaining Wall ❑Fence
s 6017.00 ❑Remodel
[]Porch ❑Shed sq ft
Sq,lare feet: ❑Addition
❑Demolition ❑Window/Door Replacement
❑ Garage -Attached/Detach []Plumbing -provide detail on Page 2 # being replaced
Detailed Description of Work: I OAccessory Structure
Mechanical -provide detail on Page 2 ❑141isc Other
INSTALL GAS FIREPLACE WITH GAS LINE AND VENTING, HEAT & GLO, 6KX-BL,
Signature of this application by tho !,,gal property owner or a licensed contractor, as the owners representative, is required and authorizes the Zoning Administrator or designee and the Building
Official or designee to enter upon the property to pedorm needed inspections. Entry may be without prior notice. I hereby acknowledge that I have read this application and stale that all Information
is true and correct to the best of riy. knrL�4e8ge I further agree that all work performed will 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. 1 agree to pay all plan review fees even If I choose not to proceed with the work. Permit
expires when work Is not commenced within 180 da fr ate I 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 M ins ection, will be sub to a penal
DATE: 6-30-25
SIGNATURE OF APPLICANT:
PRINTED NAME: DOUG CAR SON
This is the signature of: []Owneror ❑p Owner's Representative
OCCUP. TYPE: CONST. TYPE: CODE:
BLDG SPRINKLED Yes / No
VALUATION $
Permit Fee: $
Park Dedication: $
Plan Review Fee: $
SAC Charge: $
State Surcharge: $
WAC Charge: $
Site Inspection Fee: $
Sewer Hook -Up: $
S.E.C. Fee: $
Water Hook -Up: $
Investigation Fee / Other Fee: $
Sewer Trunk: $
Copy Charge ($.25 per 8.5x11 page) $
Water Trunk: $
0
License Check ($5) / Lead Check ($5) $
Water Meter $
N
SUB -TOTAL $
City Fee: $
Plumbing Fee (from Page 2) $
Other: $
v
Mechanical Fee (from Page 2) $
TOTAL DUE: $ 1(]
LL
Special Conditions/Required Setbacks:
O
Building Approval By:
DATE:
Printed Building Approval y:
❑ License Verification ❑ Lead Verification - Checked By:
City Approval By:
DATE: ! )
Paid: ,� Date: I Receipt
By:
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: FIRESIDE HEARTH & HOME Address:2700 FAIRVIEW AVE N
Citv:ROSEVILLE State: MN zi :55113 Phone:651-638-3329 Fax:
State Bond No:MB662572 lContact
Name:DOUG CARLSON
Email: ROSEVILLE BUILDER OPS@HNICORP. COI
Contact Phone:651-638-3329
Detailed Description of Work:
INSTALL GAS FIREPLACE WITH GAS LINE AND VENTING, HEAT & GLO, 6KX-BL,
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
Air Conditioning System Bath Fan
1 Fireplace
Air Exchanger Grill
Unit Heater
1 Fireplace
Water Heater _
Unit Heater
Grill
In Floor Heat
Dryer
Gas Loq
Strnre
Offlre Use Only:
❑ Replacement (one fixture only, no piping or vent changes)
Mechanical Permit Fee: $
17 Addition/Remodel
Gas Line Permit Fee: $
❑ New Construction
State Surcharge: $ 1.00
❑ Other
Other: $
_
Total Mechanical Permit: $
PLUMBING IINFORMATION
Plumbing Contractor:
Address:
City: State: Zip: 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
❑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 $ 1.00
[]New Construction
Other: $
❑Other
Total Plumbing Permit: $
RECEIPT
City of Spring Park
4349 Warren Ave, Spring Park, MN 55384
(952)471-9051
25SP-00041 I Mechanical (Residential)
Payment Amount: $106.00
SPRING PARK
On Lake 9111nnetonka
Receipt Number: 452
July 1, 2025
Transaction Method Payer Cashier Reference Number
Credit Card Fireside Hearth and Home Jamie Hoffman G9GSHS
Comments
Assessed Fee Items
Fee items being paid by this payment
Assessed Fee Item Account Code Assessed Amount Paid Balance Due
On
06/30/25 State Surcharge (Fixed) $1.00 $1.00 $0.00
06/30/25 Residential Mechanical Permit $105.00 $105.00 $0.00
Totals. $106.00 $106.00
Previous Payments $0.00
Remaining Balance Due $0.00
Application Info
Property Address Property Owner Property Owner Address
2433 BLACK LAKE RD PHILLIP ANTHONY & DEBRA 17 OAK LANE
SPRING PARK, MN 55384 LANE HOLINKA SPRINGFIELD, MN 62712
Description of Work
Install gas fireplace with gas line & venting, heat & glo, 6kx-bl
Valuation
Jamie Hoffman
From:
payment@thepaymentgroup.com
Sent:
Tuesday, July 1, 2025 9:05 AM
To:
Jamie Hoffman
Cc:
payment@thepaymentgroup.com
Subject:
CHRISTA WEGWART Permit Payment to Spring Park, MN - Permits & Licenses from TPG
Dear Spring Park, MN - Permits & Licenses,
CHRISTA WEGWART has made a web Payment through The Payment Group for:
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CHRISTA WEGWART
Tuesday, 01 July 2025 09:05:15 CT
G9GSHS
4616
MasterCard
FIRESIDE HEARTH & 2433 BLACK LAKE
HOME RD, SPRING 25SP-00041 $106.00
PARK,MN, 55384
CHRISTA WEGWART can be reached at: 651-638-3329 or
ROSEVILLE_BUILDER_OPS@HNICORP. COM if there are any questions regard ingthis payment.
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