Permits - Permit# 26SP-00062 - 2401 Black Lake Road - 7/22/2026 City of Spring Park Mechanical (Residential
4349 Warren Ave, Spring Park, MN 55384
SPRING PARK 26SP-00062
Phone:(952)471-9051 Fax: (952)471-9160
n La ke Yinneton°a
For Inspections: (952) 442-7520
Date Issued: 07/22/2026 Property Owner: BLAINE PETERS
Expiration Date: 01/18/2027 Mailing Address: 2401 BLACK LAKE RD
Job Site Address: 2401 BLACK LAKE RD, SPRING
PARK, MN 55384 SPRING PARK, MN 55384
Category: Residential Miscellaneous Phone:
Permit Type: Mechanical (Residential) Email: blaine.peters@delta.com
Valuation:
Description of Work:
Replace Furnace
Subdivision: ROSE LAWN MINNETONKA Required Setbacks:
Parcel ID: 18-117-23-43-0185
Filing:
Lot: 8 Actual Setbacks:
Block:
Total Sq Ft:
Contractors: Fee Items Amount
Primary RESIDENTIAL HEATING AND AIR State Surcharge(Fixed) $ 1.00
CONDITIONING INC (612)724-1899
Residential Mechanical Permit $75.00
Mechanical RESIDENTIAL HEATING AND AIR
CONDITIONING INC (612)724-1899 Total Fees: $76.00
NOTICE
Signature of Applicant/Date Building Department Signature/Date
07/22/2026
MUST BE POSTED ON JOB SITE
INSPECTION CARD
City of Spring Park
SPRING PARK
On Gake?bfinnetonka 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.: 26SP-00062 PERMIT TYPE: (Residential) ISSUED DATE: 07/22/2026 EXPIRATION DATE: 01/18/2027
18-117-23-
PROJECT ADDRESS: 2401 BLACK LAKE RD,SPRING PARK,MN 55384 PARCEL NO.: 43-0185
OWNER: BLAINE PETERS OWNER PHONE:
RESIDENTIAL HEATING AND AIR
CONTRACTOR: CONDITIONING INC CONTRACTOR PHONE: (612)724-1899
Residential Heating and Air
APPLICANT: Conditioning-Anne APPLICANT PHONE: (612)724-1899
DESCRIPTION OF WORK: Replace Furnace
CONSTRUCTION TYPE: OCCUPANT LOAD:
DATE DATE
INSPECTION INSP PASSED COMMENTS INSPECTION INSP PASSED COMMENTS
Mechanical Rough-In Air/Hydrostatic Test
Reports Mechanical Final
Fire Approval: Date: Engineering Date:
Approval:
PW Approval: Date: Other( ): Date:
To request an inspection:(952)442-7520
Page 1 of 1
CITY OF SPRING PARK
BUILDING PERJMIT
PAGE 1
4349 Warren Avenue (p^
Spring Park,MN 55384 El Email completed form to City of — o�
Spring Park to the attention of;
Phone: 952-471-9051 jkhoffman@ci.spring-park.mn.us Routed to SAFEbuilt
Email:jkhoffman@ci.spring-park.mn.us
yu
SITE ADDRESS:Ld 7O i Black Lake Road 2_4 V PID:
1)Was the home constructed before 1978?(YES❑,continue with line 2, NO❑continue without completing EPA Section)
2)Will the work disturb z6 sq ft of interior painted surfaces or z20 sq it 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[3,you MUST Attach Certification Information, NO ❑complete line 5)
5)EPA Contractor Certification Number: NAT-
PROPERTY OWNER:Blaine Peters Address:2401 Black Lake Road
city: Spring Park State:MN zip:55384 Email:blaine.peters@delta.com
Contact Name: Phone:
CONTRACTOR: Residential Heating and Air Conditio Address:7454 Washington Ave S
city:Eden Prairie State:MN zip:55344 Phone:612-724-1899 Fax:612-724-2018
Contractor License No:MB003627 Contact Name: Anne K Phone:612-724-1899
Email: anne@resheatandair.com
ARCHITECT: NSA Address:
City: State:MN zip: Phone: Fax:
Email: Contact Name: Phone:
TYPE OF WORK: El New Construction ❑Deck []Re-Roof
❑Commercial EiResidential ❑Change of Use ❑Pool []Re-Side
EST.VALUATION OF WORK ❑Finish Basement ❑Retaining Wall []Fence
$ 13598.00 ❑Remodel ❑Porch ❑Shed sq ft
Square feet: ❑Addition ❑Demolition ❑Window/Door Replacement
❑Garage-Attached/Detach ❑Plumbing-provide detail on Page 2 #being replaced
Detailed Description of Work: 0 Accessory Structure ElMechanical-provide detail on Page 2 ❑Misc Other
Replacing furnace4 with Carrier 59TP7A080V17 97%80,000 btu's r `gz-6-" v r n w W t
C-CA-t•f c 11_( ac l t) *0 9 U v t ( 9-1 `f (� 0 uo (9
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 an the Building
Official or designee to enter upon the property to perform neede •nspeclions.Entry may be without •or notice.I hereby acknovAedge that I have read this application and state that all information
is true and correct to the best of my knowledge.1,further agr t t all work performed will be i o an.with approved plans,specifications and conditions and to abide by all ordinances of the
Municipality and the laws of the State of Minnesta regard g ions taken pursuant t11h mi 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 daysfr d e of permit or if work is ,abandoned,or not Inspected for 180 days.Work beyond the scope of this permit,or work without
a perrnit or Inspection,will be sub'ect to a penaltv.
SIGNATURE OF APPLICANT: DATE:07/21/2026
PRINTED NAME: Anne Kolner This is the signature of: []Owner or []Owner's Representative
OCCUP.TYPE: CONST.TYPE: CODE: BLDG SPRINKLED Yes/No
VALUATION:$ 13 a v
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 8.5xl1 page) $ Water Trunk: $
0 License Check($5)/Lead Check($5) $ Water Meter$
Lu SUB-TOTAL $ SAC or City Fee:$
D Plumbing Fee(from Page 2) $ Other: $
W Mechanical Fee(from Page 2) $ TOTAL DUE: $
LL Special Conditions/Required Setbacks:
O
Building Approval By: DATE:
Printed Building Approval B ❑ License Verification❑ Lead Verification-Checked By:
City Approval By: DATE: -7
Paid:, Date: Receipt No. 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: ,- V,, a ,.Address:-1LA 5 4 .�<; h � +vA Q S
Cit : a - State: 1--\s/ Zip: j S �l Phone: n 1 z.- 2- -t Fax: 6 1 L. 7 Zy- ZU( S�
State Bond No: 1v�3 3 :, Z'I JContact Name:
Email: r, w 0—N JContact Phone: E, L-Z ZLJ—1$
Detailed Description of Work:
inn I "(-k^� -Tvr LL);-tVN C&�f(-XLr- 5cT,) 7ArDS,1) `T �i7 ")(> 8c),L100, �,`tJ
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
FQuantity Quantity Quantity
urnace 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
Office Use Only:
If Replacement(one fixture only, no piping or vent changes) Mechanical Permit Fee: $
❑Addition/Remodel Gas Line Permit Fee: $
❑New Construction State Surcharge: $ 1.00
❑Other Other: $
Total Mechanical Permit: $
PLUMBING INFORMATION
Plumbing Contractor: Address:
City: State: Zip: Phone: Fax:
Plumbers License No: State Bond No:
Contact Name: Contact Phone:
Email:
Detailed Description of Work: j
i
Indicate type of project aril fixtures you will be installing or re acing (include count for each type of fixture):
PLUMBING FIXTURES
Quantity Quantity Quantity
Water Heater Shower Laund Tub
❑Gas ❑Electric Dishwasher Rough-In uture Fixture
Water Softener Clothes Washer Sump
Lawn Sprinkler System Ice Maker Line Water Piping stem
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: $
Jamie Hoffman
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Sent: Wednesday, July 22, 2026 7:43 AM
To: Jamie Hoffman
Cc: payment@thepaymentgroup.com
Subject: DIONE KALLSTROM Permit Payment to Spring Park, MN - Permits & Licenses from TPG
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Dear Spring Park, MN - Permits & Licenses,
DIONE KALLSTROM has made a web Payment through The Payment Group for:
Payment Information
Date Paid: Wednesday, 22 July 2026 07:43:04 CT
Confirmation: QKH5GD
Credit Card Number(last 4 7819
digits):
Credit Card Type: MasterCard
Busines Full Address - IPermitor
payment
First Name Last Name,, Name City, State & License Amount
Zip Number
RESIDENTIAL EDEN PRAIRIE 2401 BLACK
DIONE KALLSTROM HEATING AND MN 55344 LAKE4 ROAD $76.00
AIR CO
DIONE KALLSTROM can be reached at : 612-724-1899 or anne.kolner@hotmait.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
SPRING PARK
26SP-00062 I Mechanical (Residential) On Lade.`Minnetonka
Receipt Number: 581
Payment Amount: $76.00 July 22,2026
Transaction Method Payer Cashier Reference Number
Credit Card Residential Heating and AC Jamie Hoffman QKH5GD
Comments
Assessed Fee Items
Fee items being paid by this payment
Assessed Fee Item Account Code Assessed Amount Paid Balance Due
On
07/21/26 State Surcharge(Fixed) $1.00 $1.00 $0.00
07/21/26 Residential Mechanical Permit $75.00 $75.00 $0.00
Totals: $76.00 $76.00
Previous Payments $0.00
Remaining Balance Due $0.00
Application Info
Property Address Property Owner Property Owner Address Valuation
2401 BLACK LAKE RD BLAINE PETERS 2401 BLACK LAKE RD
SPRING PARK, MN 55384 SPRING PARK, MN 55384
Description of Work
Replace Furnace