Permits - Permit# 26SP-00018 - 3901 Mapleton Avenue - 4/22/20267? ' City of Spring Park
4349 Warren Ave, Spring Park, MN 55384
PARK Phone:(952) 471-9051 Fax: (952) 471-9160
For Inspections: (952) 442-7520
Footing/Foundation Only
(Residential)
26SP-00018
Date Issued: 04/21/2026
Property Owner: CATHERINE L ABENE & MAREN
Expiration Date: 10/18/2026
LINDER
Job Site Address: 3901 MAPLETON AVENUE, SPRING
Mailing Address 3901 MAPLETON AVE
PARK, MN 55384
Category: Residential New
SPRING PARK, MN 55384
Permit Type: Footing/Foundation Only (Residential)
Phone: (612) 483-8060
Valuation: $29,300.00
Email:
Description of Work:
Installation of piers
Subdivision:
Required Setbacks:
Parcel ID: 1711723330069
Filing:
Actual Setbacks:
Lot: 18
Block:
Total Sq Ft:
Contractors:
Fee Items
Amount
Primary GROUNDWORKS MINNESOTA LLC (612)
State Surcharge
$ 14.65
424-5165
Building GROUNDWORKS MINNESOTA LLC (612)
424-5165
Residential Building Permit
Contractor License Look -up
$ 574.50
$ 5.00
Residential Plan Review
$ 373.43
Total Fees:
$ 967.58
NOTICE
Signature of Applicant/Date
Building Department Signature/Date
04/21/2026
MUST BE POSTED ON JOB SITE
i-1 INSPECTION CARD
City of Spring Park
SPRING PARK
On Lake9bfinnetonka 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.
Footing/Foundation
PERMIT NO.: 26SP-00018 PERMIT TYPE: Only (Residential) ISSUED DATE: 04/21/2026 EXPIRATION DATE: 10/18/2026
1711723330
PROJECT ADDRESS: 3901 MAPLETON AVENUE, SPRING PARK, MN 55384 PARCEL NO.: 069
CATHERINE L ABENE $ MAREN
OWNER: LINDER OWNER PHONE: (612) 483-8060
CONTRACTOR: GROUNDWORKS MINNESOTA LLC CONTRACTOR PHONE: (612) 424-5165
APPLICANT: GROUNDWORKS - KELLY APPLICANT PHONE: (612) 424-5165
DESCRIPTION OF WORK: Installation of piers
CONSTRUCTION TYPE: OCCUPANT LOAD:
DATE DATE
INSPECTION INSP PASSED COMMENTS INSPECTION INSP PASSED COMMENTS
Footings (Prior to Final
backfil l)
Fire Approval: Date: Engineering
Approval:
PW Approval: Date: Other
To request an inspection: (952) 442-7520
Date:
Date:
Page 1 of 1
The field copy of these plans must be kept
on -site and made available to inspector
during all inspections.
To schedule inspections call
(952) 442-7520
Please have the permit number and street
address ready at the time of the call.
Read all attached materials.
Everyone performing work to
which the code is applicable
shall comply with the code.
Hardwired and interconnected smoke alarms are
required in the following locations:
•1 (one) in every bedroom
-1 (one) in the area outside every bedroom
-At least 1 (one) per floor where no bedrooms exist
including basements and habitable attics
Existing spaces where no electrical work has taken place
may have battery operated smoke alarms that are not
interconnected.
1 {ones Carbon Monoxide (CO) alarm is required
outside of and within 10-feet of every bedroom or
sleeping area. A CO alarm is required on every level
that contains a bedroom or sleeping area.
CO alarms may be hardwired, plugged into an outlet or
battery operated.
All required alarms must be installed and operational
at time of final building inspection.
Registered Plans
All construction shall comply with the approved plans.
Construction details in plans prepared and certified by registered design professionals cannot be altered
without prior written approval from the designer of record and review & approval from the Department of
Building Safety.
Submit all plan revisions to the Department of Building Safety for review, prior to their construction.
Reviewed for Code Compliance
This review is limited to the submitted scope of work, is based upon the supposition that the plan
accurately depicts the intended construction and end -use, that the necessary legal authority has
been obtained to construct the project and work is subject to code compliance and field
inspection during construction.
By: Nick augf Type of Construction: Not Applicable
Date: 4/17/2026 Occupancy Classification: IRC-1 Single Family
Permit #: 26SP-00018 Code Edition: 2020 MN Residential Code
ENGINEERING REPORT FOR FOUNDATION STABILIZATION
BUILDING DEPT.:
- roundworks'
REFERENCE CODE: Minnesota Residential Code 2020
DATE: March 11, 2026 —11
PROJECT: Cathy Abene
ADDRESS: 3901 Mapleton Avenue Spring Park, MN 55384
CUSTOMER #: 334527
INSPECTOR: Brock Woodruff INSPECTION DATE: 2/28/2026
OVERVIEW:
As requested by the owner/representative of the above referenced project (client), the field inspector visited the project and performed a visual inspection of readily accessible
foundation areas (walls and piers) and associated structural framing elements. Unless noted below, destructive testing and evaluation was not performed. Based on this inspection, the
field inspector and the client agreed to the following "Scope -Of -Work".
SCOPE -OF -WORK: 11 SettleStop Push Pier [SEE PRODUCT DETAILS -ATTACHED]
QUANTITY: 13 [SEE LOCATION PLAN]
SPACING (Typ.): 6.0 [±12"ALLOWABLE]
GENERAL ISSUE: 1�4 portion of the structure shown in the attached sketch is settling and needs to be stabilized.
PROP. SOLUTION: Ivnstall thirteen (13) push piers, as shown on the attached plan, to stabilize the foundation system and help
Mitigate further vertical movement.
EXISTING STRUCTURE DETAILS:
• Classification: ISingle Family Residence
• Stories: �1
• Construction Type: ood-Frame
• Exterior:[Vinyl Siding
• Foundation Type: asement/Crawlspace (11
• Wall Design Loads: Live + Dead: 1,5C
SOIL CONDITIONS:
• Minimum Frost Depth: 42 in.
• Assumed Allowable Bearing Capacity: I=Ipsf
• Foundation Wall Height: 4.07 fL
• Foundation Backfill Height: 3.0 ft.
• Year Built: 1910
Walls on Spread Footings)
[Based on Typical IRC Load Tables]
NOTE: For exterior footings ONLY.
Per Referenced Code Above
I hereby certify that this plan, specification,
or report was prepared by me or under my
direct supervision and that I am a duly
Licensed Professional Engineer under the laws
of the scat of MinneTockson
Signature:-
Name: Bethany Nichol
Date: 03/11/2026 License Number: 64313
Page 1 of 4
DESIGN CALCULATIONS AND SUMMARY
BUILDING DEPT: G roundworks
PROJECT: Cathy Abene
ADDRESS: 3901 Mapleton Avenue Spring Park, MN 55384
DATE: March 11, 2026
DESIGN CALCULATIONS:
• Based on load criteria and building characteristics outlined in the front page of this report,
assume a support load of: plf 1,500
• Push Piers Design Spacing: feet Calculation for additional 12" to allow for field
adjustments; See plan for proposed pier spacing.
• Using the support load and design pier spacing indicated above, the load on each ier will be:
PIER LOAD = Support Load x Spacing = 10,500 lbs DESIGN ACCEPTABLE [SEE NOTE 1 BELOW]
IFPIER LOAD LESS THAN ALLOWABLE LOAD OF 24,060 LBS
MINIMUM DRIVING FORCE = 21,000 lbs Or when lift is achieved, whichever is first.
DESIGN COMMENTS:
NOTE 1: The pier load is less than the "Average' allowable load per pier; Factor of Safety (FS) exceeds 2.
Refer to the Product Evaluation Report for additional information on the allowable system capacity ratings.
PPM1617-34 or PP21617-78 On a Concrete Slab PP21617-34 or PP21617-78 On a Crawl Spate
�-.arr r:c• r•s�
FIGURE 1—PP21617J4 BRACKET ASSEMBLY
I hereby certify that this plan, specification,
or report was prepared by me or under my
direct supervision and that I am a duly
Licensed Professional Engineer under the laws
of the stat of MinneTackson
Signature
Name: Bethany Nichol
Date: 03/11/2026 License Number: 64313
Page 2 of 4
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COMMENTARY & LIMITATIONS
BUILDING DEPT: C I'Oundworks
PROJECT: Cathy Abene
ADDRESS: 3901 Mapleton Avenue Spring Park, MN 55384
DATE: March 11, 2026
GENERAL COMMENTARY
The recommendations provided herein are based on our understanding of the project and subsurface characteristics at the time of
this report. If differing project conditions are encountered, field personnel shall notify Engineering Department immediately for
resolution.
This analysis relies solely upon the accuracy of information provided to Engineering by the contractor's sales representative.
Engineering did not diagnose this home and is not responsible for any misdiagnosis provided by the sales representative.
Additionally, the engineering analysis is based on presence of competent/adequate footing under existing foudation walls.
Contractor shall verify presence of competent footing prior to installation of piers. If no footing is present or conditions of existing
footing(s) are poor/compromised, Engineering Department shall be notified immediately for direction.
Unless determined by a site -specific soil boring and laboratory soils analysis, the bearing capacity (net allowable soil pressure)
referenced in the first page of this report is based on our experience with soils in the project area as well as the "Presumptive Load -
Bearing Values" as outlined in the referenced version of the IRC. Any perimeter pier may be installed on the interior or exterior of the
structure at the discretion of the Contractor. It should be noted that subsurface conditions can vary across the site due to natural
occurence or because of previous construction, clearing, or cut/fill grading operations.
The exterior grade around the building shall slope away from the foundation, providing a minimum of 6 inches of fall within the first
10 feet. Downspouts shall be properly maintained and directed to discharge water away from the structure. All trenches shall be
backfilled with well -compacted soil and graded to ensure positive drainage, preventing any potential water intrusion.
LIMITATIONS
The information presented in this report is provided as support to proposed pier installation as outlined in the previous pages. This
report does no represent commentary on causation of foundation or structural damage (flood, wind, ground subsidence or heave,
etc.). Any additional work shall be considered beyond the scope of these analyses.
FOUNDATION PIER PRODUCT REFERENCES:
• SettleStop Push Pier Groundworks Product Evaluation Report #4001
Additional Documents:
I hereby certify that this plan, specification,
or report was prepared by me or under my
direct supervision and that I am a duly
Licensed Professional Engineer under the lam
of the stot of Minnesota.
Signature:
Name: Bethany Nichol ockson
Date: 03/11/2026 License Number: 64313
Page 3 of 4
PRODUCT EVALUATION REPORT
SettleStop Push Pier System
Gxoundworks
REPORT # 4001R - March 14, 2025
1. General Information
The SettleStop Push Pier System is a steel foundation support system consisting of a steel shaft, reinforcing sleeve and bracket.
The bracket is used to transfer compression loads from existing foundations/structures to the end of the pier. The installation
pressure applied to the lead section transfers the loads to suitable soil bearing strata below. The intended use of this product is for
residential structures governed by the International Residential Code (IRC).
Product Description
The SettleStop Push Pier System consists of steel shafts connected to a bracket that support existing foundations/structures. The
steel shaft assemblies consist of a starter section and one or more extension sections. The bracket assemblies consist of the
bracket body, external sleeve, bracket cap plate, threaded rods and nuts. The bracket is fitted below the structure's foundation to
provide support. The starter section is installed through the bracket body and external sleeve and is pushed into the ground by
application of hydraulic pressure using a hydraulic ram. Extensions are connected (inserted) to the lead section and to each other.
The assembly continues to be driven into the soil until reaching the required load capacity. Capacities are determined by
correlation to the pressure required to continue pushing the assembly. Bracket cap plate, threaded rods and nuts are used to
secure the bracket with the bottom of the footing to ensure load transfer from the structure onto the bracket and shaft assembly.
3. Component Description
3.1. Starter Section: The starter section has a 2-7/8" (73 mm) outside diameter x 0.165" (4.2 mm) nominal thickness and length
of 50" (1270 mm). The leading end of the starter section is fitted with a coupler (friction reducing collar) on the outside of the
pipe with a 3-1/2" (88.9 mm) outside diameter x 0.216" (5.5 mm) nominal thickness and length of 1" (25.4 mm). The bottom of
the coupler is 1 /4" (6.4 mm) from the end of the starter section and connected with a 1 /4" (6.4 mm) fillet weld around the
perimeter of the top of the coupler. The tubing and coupler conform to ASTM A500 Steel, Grade C (or equivalent standard)
with a minimum yield strength of 50 ksi (345 MPa) and a minimum tensile strength of 62 ksi (425 MPa). The shaft portion of
the starter section is hot dip galvanized in accordance with ASTM All 057 (or equivalent standard). See Figure A-1.
3.2. Extension and Coupler: The extension has a 2-7/8" (73 mm) outside diameter x 0.165" (4 mm) nominal thickness and length
of 36" (914.4 mm). The extension has a 9/16" (14.3 mm) thru hole located 1" (25.4 mm) from the end of the leading section.
The leading end of the extension is fitted on the inside of the pipe with a coupler with a 2-1/2" (63.5 mm) outside diameter x
0.180" (4.6 mm) nominal thickness and length of 6" (152.4 mm). The coupler is embedded 3" (76.2 mm) into the leading end of
the extension. The leading end of the extension will have a plug weld on the near and far side of the pipe through the 9/16"
(14.3 mm) hole. The extension material conforms to ASTM A500 Steel, Grade C (or equivalent standard) with a minimum yield
strength of 50 ksi (345 MPa) and a minimum tensile strength of 62 ksi (425 MPa). The coupler material conforms to ASTM
A513 Steel, Grade 1026 (or equivalent standard) with a minimum yield strength of 40 ksi (276 MPa) and a minimum tensile
strength of 60 ksi (414 MPa). The shaft material of the extension section is hot dip galvanized in accordance with ASTM A1057
(or equivalent standard). See Figure A-2 for details.
3.3. External Sleeve: The external sleeve has a 0.216" (5.5 mm) nominal thickness and a total length of 48" (1219.2 mm). The
following end of the external sleeve linearly transitions from an outside diameter of 4-1/32" (102.4 mm) to 3-1/2" (88.9 mm)
from 0 to 1-3/16" (0 to 30.2 mm). The external sleeve has a diameter of 3-1/2" (88.9 mm) from 1-3/16" (30.2 mm) to 48"
(1219.2 mm) from the following end. The sleeve material conforms to ASTM A500 Steel, Grade B (or equivalent standard)
with a minimum yield strength of 46 ksi (315 MPa) and a minimum tensile strength of 58 ksi (400 MPa). The external sleeve is
hot dip galvanized in accordance with ASTM A123 (or equivalent standard). See Figure A-3 for details.
3.4. Bracket and Cap Plate: The bracket is constructed from round structural steel tubing and plates, which are welded together
to form the bracket geometry. The L-shaped seat of the bracket consists of bent 3/8" (9.53mm) plate. The plate is 16" (406.4
mm) and bent into a 9" (228.6 mm) horizontal leg and a 7" (177.8 mm) vertical leg. The vertical leg of the seat is welded to a 4"
outside diameter (101.6 mm) pipe sleeve with nominal 0.18" (4.57 mm) thickness and 11-1/2" (292.1 mm) length. Two angled
gusset plates are fabricated using 3/8" (9.53 mm) plate are welded to the underside of the horizontal leg of the seat and to the
side of the pipe sleeve. The gusset plates have one CNC cut hole per plate. Two 1-21/32" (42 mm) outside diameter x 1/8" (3.2
mm) nominal thickness and a length of 2-1/8" (54 mm) tube spacers are welded on each side of the pipe sleeve and a plate
which is welded to the vertical leg of the bracket. A 8" (203.2 mm) x 7" (177.8 mm) x 1/4" (6.4 mm) stopper plate is welded to
the bottom of the angled gusset plates and pipe sleeve. The stopper plate has a 4" diameter (101.6 mm) hole cut to
accommodate for the pipe sleeve. A 9" (228.6 mm) by 4" (101.6 mm) cap plate with nominal thickness of 1" (25.4 mm) is
Paae 1 of 3
PRODUCT EVALUATION REPORT
SettleStop Push Pier System
0,roundworks"
REPORT # 4001R — March 14, 2025
provided to complete the bracket assembly. The plate is fitted with a 3/4" (19 mm) ring of 3-1 /2" outside diameter tubing (89
mm) to help align and center the plate at the top of the shaft assembly. The cap plate has two 1.1" (27.9 mm) diameter holes,
which match holes in the bracket plate. Plate components for the bracket assembly (excluding the stopper plate) conform to
ASTM A36 (or equivalent standard) steel with a minimum yield strength of 36 ksi (250 MPa) and a minimum tensile strength of
58 ksi (400 MPa). The stopper plate conforms to ASTM A572, Grade 50 (or equivalent standard) with a minimum yield strength
of 50 ksi (345 MPa) and a minimum tensile strength of 65 ksi (450 MPa). The pipe sleeve and tube spacer material conform to
ASTM A500 Steel, Grade B (or equivalent standard) with a minimum yield strength of 46 ksi (315 MPa) and a minimum tensile
strength of 58 ksi (400 MPa). The bracket assembly is hot dip galvanized in accordance with ASTM A123 (or equivalent
standard). See Figures A-4, A-5, and A-6 for details.
3.5. Lifting Rods, Bolts, and Nuts: The lifting rods are 3/4" (19.05 mm) x 16" (406.4 mm) long all -thread rods meeting ASTM
A193, Grade B7 (or equivalent standard), or 3/4" (19.1 mm) x 18" (457.2 mm) long 4.5 coil rods meeting ASTM Al08, Grade
1045 (or equivalent standard). For the all -threaded rods, the nuts should be 0.75"-10 per ASTM A194, Grade 2H (or equivalent
standard). For the coil rods, the nuts should be 3/4-4.5 per ASTM A1045 (or equivalent standard). The washers for both the
threaded and coil rods are 3/4" flat washers meeting ASTM F436 Type-1 (or equivalent standard). The lifting rods and
matching nuts must be electroplated perASTM F1941 FE/ZN (or equivalent standard).
4. Code Compliance
The strength design of the SettleStop Push Pier System complies with Section 301.1.3 of the 2015, 2018, and 2021 IRC by
designing the components in accordance with accepted engineering practice and the applicable material codes (ANSI/AISC 360 —
Specification for Structural Steel Buildings).
S. Design Basis and Capacity
The capacities of the various components of the push pier system are determined by a combination of analysis and computer
modeling. Design methodologies were selected in accordance with ICC AC517, 2020 Edition, "Acceptance Criteria for Push Pier
Foundation Systems". Based on the guidance provided in ICC AC517, the capacities of the two primary structural elements of the
push pier system were evaluated. The two primary structural elements are the Bracket Capacity (P1) and Shaft Capacity (P2).
The Bracket Capacity (P1) was analyzed using finite element modeling to determine the ultimate and allowable compressive load.
The model results were compared to full-scale bracket load testing previously performed (by others) to validate the results.
The Shaft Capacity (P2) was analyzed considering an unbraced length of 5'. Calculations were performed in accordance with
ANSI/AISC 360-22, "Specifications for Structural Steel Buildings".
Details of the calculations and analysis performed are documented in the Groundworks report titled "NSI Push Piers Analysis
Report".
5.2. Design Capacities
5.2.1. Bracket/Shaft Capacity
Table 1 provides the allowable compressive capacity for the bracket/shaft assembly. It should be noted that the bracket/shaft
assembly is not intended to resist tension (uplift) or lateral loading (shear).
TABLE 1 — Allowable Capacity for Bracket/Shaft Assembly (ASD)
Allowable Capacity 24.06
Compression (kips)
5.3. Items Requiring Verification
The following items are related to the use and determination of code compliance for the SettleStop Push Pier system, but are not
within the scope of this evaluation report:
5.3.1. Determination of foundation loads imposed on the push pier assembly.
Page 2 of 3
PRODUCT EVALUATION REPORT Gdroundworks
SettleStop Push Pier System REPORT # 4001R — March 14, 2025
5.3.2. Determination of the ability for the foundation wall/footing to adequately span distance between push piers.
6. Installation and Use
Where required by the code official, engineering calculations and construction documents consistent with this report must be
submitted to the code official for approval. The documents must address the items in Sections 5.2 and 5.3, consistent with the
requirements of this report. The documents must be prepared by a registered design professional where required by the statutes of
the jurisdiction in which the project is to be constructed. Installation of the SettleStop Push Pier System must comply with this
report, any published installation instructions, and the approved plans. Some general installation details are shown in Appendix B.
6.1. The retrofit bracket and push pier lead/extension components shall be verified to be those described in Sections 3.1, 3.2, and
3.3 and 3.4. The lifting rods, coupler bolts, and nuts intended to be used for installation shall be verified to meet the
requirements described in Section 3.5.
6.2. The retrofit bracket must be installed within 2 inches of the side and flush to the bottom of foundation wall to ensure full
bearing of the foundation wall on the base plate.
6.3. The lead section and extension(s) shall be installed as close to vertical as practical.
6.4. The push piers shall be driven to the minimum specified driving force provided in the project -specific engineering plans.
6.5. Hydraulic ram -specific correlation charts should be used to determine the proper pressure required to achieve the specified
driving force.
6.6. The crew shall furnish field logs indicating the hydraulic ram(s) used, driving pressures, and number of extensions/total length
for each push pier.
roved Manufacturers
NSI (INDIA) LTD.
Beltala Chamrail
Howrah — 711 114
West Bengal, India
Helical Anchors, Inc.
5101 Boone Avenue North
Minneapolis, Minnesota 55428
Page 3 of 3
PRODUCT EVALUATION REPORT
SettleStop Push Pier System
APPENDIX A
Component Details
T
03.5'
0216-
COUPLER
50
02k
0.165.
026"
— —
— — — — — — — — — — — — — — —
FIGURE A-1 — STARTER SECTION (50" LENGTH)
13 -
119
Groundworks
REPORT # 4001 R — March 14, 2025
�6
0 180'
I
0*
LT ---------------L------
Tm Hole 06' 0.165,
3- Phy Weld Near and Far Side.
FIGURE A-2 — EXTENSION (36" LENGTH)
1 ---------------------------------------- ----------------------------------------1-------
4h " 03.5"
0216"
48"
FIGURE A-3 EXTERNAL SLEEVE
Page A-1
PRODUCT EVALUATION REPORT
SettleStop Push Pier System
PJ4"
6
H121„
32
11.5"
0.18"
t,
Groundworks a
REPORT # 4001 R —March 14, 2025
Q..
3..
4
FIGURE A-4 — BRACKET (FRONT AND SIDE VIEM
FIGURE A-5 — BRACKET
(BACK AND TOP VIEW)
9"
6.5"
+ + 4"
fd1.1"
) 1
OJ3.5� 0.75"
0.216" � r`
FIGURE A-6 — BRACKET CAP PLATE
Page A-2
PRODUCT EVALUATION REPORT Groundworks"
SettleStop Push Pier System REPORT # 4001 R - March 14, 2025
CRAWL
SPACE
OR
BASEMENT
FIRM BEAR
STRATA
APPENDIX B
Installation Details
EXISTING
STRUCTURE
TRIM FOOTING AS
REQUIRED t2" TYP_
LIFTING ROD
& NUTS
CAP
BRACKET
BODY
PATENT
PENDING
EXTERNAL
SLEEVE
\---GALVANIZED
STARTER PIPE
WITH FRICTION
REDUCING COLLAR
FIGURE B-1 - PUSH PIER INSTALLATION
(BASEMENT OR CRAWLSPACE RESIDENCE)
XISTING
STRUCTURE
SLAB WITZ-,.—�"--�IERCAP
IFTING ROD
TURNED& NUTS
DOWN FOOTING
BRACKET BODY
PATENT PENDING
FIRM BEARIN
STRATA XTERNAL
SLEEVE
%—GALVANIZED
STARTER PIPE
WITH FRICTION
REDUCING COLLAR
FIGURE B-2 - PUSH PIER INSTALLATION
(SLAB -ON -GRADE RESIDENCE)
Paae B-1
CITY OF SPRING PARK
BUILDING PERMIT
4349 Warren Avenue PAGE 1
�d l8
Spring Park, MN 55384 ❑ Handout Given
Phone: 952-471-9051 Fax: 952-471-9160 ❑ Lead Handout Given
Route to SAF buil�'
SITE ADDRESS: 3901 Mapleton Ave PID: 17-117-23-33-0069
1) Was the home constructed before 1978? (YES p, continue with line 2, NO ❑ 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, NODline 3)
3) Are there any windows being replaced? (YES ❑, go to line 4, NODcontinue without completing EPA Section)
4) Has this home been Certified Lead Free? (YES ❑ , you MUST Attach Certification Information, NO p complete line 5)
5) EPA Contractor Certification Number: NAT - F120801-3
PROPERTY OWNER: Catherine Abene Address: 3901 Mapleton Ave
city: Sprinq Park State: MN zip: 55384 Email:
Contact Name: Catherine Abene Phone: 612-483-8060
CONTRACTOR: Groundworks Address: 6265 Carmen Ave E
city. Inver Grove HeicState: MN zip: 55076 Phone:612-424-5165 Fax:
Contractor License No: BC765730 contact Name: Kelly Saldivar Phone. 612-424-5165
Email: ibaminneapolispermits@teaminnovative.com
ARCHITECT: Address:
City: State: M N zip: Phone: Fax:
Email: Contact Name: Phone:
TYPE OF WORK: ❑New Construction ❑Deck ❑Re -Roof
[]Commercial pResidential ❑Change of Use ❑Pool ❑Re -Side
EST. VALUATION OF WORK ❑Finish Basement ❑Retaining Wall ❑Fence
$ 29.300.00 ❑Remodel ❑Porch ❑Shed sq ft
Square feet: ❑Addition ❑Demolition ❑Window/Door Replacement
100 []Garage-Attached/Detach []Plumbing -provide detail on Page 2 # being replaced
Detailed Description of Work: I ❑AcceSsory Structure ❑Mechanical -provide detail on Page 2 [DMisc Other Repair
Installation of piers.
Signature or this application by the legal property owner or a licensed contractor, as the owners representative, is required and authorizes the Zoning Aditrn,sirator or oes,9nee and the Binding
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 stale 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 all ordinances of the
Mumopafity 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 is not commenced within 180 days from dale 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 subtect toe penalty
SIGNATURE OF APPLICANT: 01. DATE: 3/18/26
PRINTED NAME: Kel1v Saldlvar This is the signature of: []Owner or pOwner's Representative
OCCUP. TYPE: CONST. TYPE: CODE: BLDG SPRINKLED Yes / No
VALUATION: $
Permit Fee: $ Park Dedication: $
Plan Review Fee: $ SAC Charge: $
State Surcharge: $ t 116415 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: $
p
License Check ($5) / Lead Check ($5) $ Water Meter $
�
SUB -TOTAL $ City Fee $
D
Plumbing Fee (from Page 2) $ Other: $
U
Mechanical Fee (from Page 2) $ TOTAL DUE: $
LL
Special Conditions/Required Setbacks:
O
Building Approval By: DATE:
Printed Building Approval By: ❑ License Verification ❑ Lead Verification - Checked By:
City Approval By: DATE -
Paid -9 r �S Date: Li
Receipt Noi 4 P By: Y1
Jamie Hoffman
From: payment=thepaymentgroup.com@mg.thepaymentgroup.com on behalf of
payment@thepaymentgroup.com
Sent: Tuesday, April 21, 2026 11:10 AM
To: Jamie Hoffman
Cc: payment@thepaymentgroup.com
Subject: KELLY SALDIVAR Permit Payment to Spring Park, MN - Permits & Licenses from TPG
ATTENTION: if you need assistance with this payment, please FORWARD this email to
tpgc-Lientsupport@r�uv_eL osn and include your request. Your client manager will respond.
Dear Spring Park, MN - Permits & Licenses,
KELLY SALDIVAR has made a web Payment through The Payment Group for:
Payment Information
Date Paid: Tuesday, 21 April 2026 11:10:06 CT
Confirmation:
J17PP4
Credit Card Number (last 4 9795
digits):
Credit Card Type:
First Name Last Name
KELLY SALDIVAR
MasterCard
Full Addres Permit or
ayment
Business Name City, State License
mount
Zip Number
GROUNDWORKS 3901 26SP-00018 $967.58
MAPLETON
KELLY SALDIVAR can be reached at: 612-424-5165 or
ibaminneapolispermits@teaminnovative.com if there are any questions regarding this payment.
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RECEIPT
City of Spring Park
4349 Warren Ave, Spring Park, MN 55384
(952) 471-9051
26SP-00018 I Footing/Foundation Only (Residential)
Payment Amount: $967.58
Transaction Method Payer Cashier
Credit Card Groundworks Jamie Hoffman
Comments
Assessed Fee Items
Fee items being paid by this payment
s
SPRING PARK
On Lake Minnetonka
Receipt Number: 542
April 21, 2026
Reference Number
J17PP4
Assessed Fee Item
On
Account Code Assessed
Amount Paid
Balance Due
04/17/26 Contractor License Look -up
$5.00
$5.00
$0.00
04/17/26 State Surcharge
$14.65
$14.65
$0.00
04/17/26 Residential Plan Review
$373.43
$373.43
$0.00
04/17/26 Residential Building Permit
$574.50
$574.50
$0.00
Totals: $967.58
$967.58
Previous Payments
$0.00
Remaining Balance Due
$0.00
Application Info
Property Address Property Owner
Property Owner Address
Valuation
3901 MAPLETON AVENUE CATHERINE L ABENE &
3901 MAPLETON AVE
$29,300.00
SPRING PARK, MN 55384 MAREN LINDER
SPRING PARK, MN 55384
Description of Work
Installation of piers