Permits - Permit# 03-16M - 2401 Black Lake Road - 1/1/2003per- 16 -;,
47/�/d�3
CITY OF SPRING PARK
4349 WARREN AVENUE
SpmG PARK, MPMSOTA 55384
952-471-9051
APPLICATION FOR MECHANICAL PERMIT'
1. You may apply for niecbanteal 11e9101ts by mail Or Is perea® at tbo City 0Mcce. Appficalioes will be
reviewed and a permit will be issued within 2 working dare.
2. Permit cards will be sent by retora snail after a review is completed. PERMITS ARE NOT VALID
LINTEL YOU RECEIVE A PERIMIIT,
3. MtichabkW..kgjp! - Complete calculations, details and rpechleaiions are required for each
heating, ventilation, bnanidificatlon-debunddilleatlon, and air cveditloafnR Installation including bait
low/beat gain calculation, deelp temperoures, equipment ratings and idendlicatioa as to tree,
mnaulactwer and model. Data shall be presented on form provided. Identification of and
gimilleations for water heatfug equipment shall ale be provided.
4L When any new construction or remodeft is involved, a separate building permit mast be obtained.
5. AD work must be done in aeeardeste with the Uniform Mecbaeteal Code/State Building Code
rogidrenteals.
& AO wwk must be latWKbd {roal" and final} Can "2-2a-a o. A 24 boar notice is required.
7. Rom Heating Test Record mast be mbmiKed before Anal.
114MICTIO" Complete afl items on this application Compute the permit fee. Sign wed date the
eerdfit edom INCOMFUNZ APPLICATIONS WILL NOT BE PROCKSSED. N you have questions,
call 952-249-AW or 952-471-901.
Please cbeck one: New -XI, Addition Repair Replace
Aesldentitil , -le Cosa amw
JOB srrla / �/ J� L�.�"L S r
owner's Name
MaNn Address _
Contracine's Name
Matling Address
✓t
,77
Number (- / a_
EMATV41G SYSTEMS
Quantity '�—
Make
Model Gs IM o
lhsel G n0
Inve Sin
UVA BTUs 0 1z,d
Output BTUs eo �—
CFM._
COOLING SYST130
�—
MKim
.� ---
Moab
Taws B. Power --�—
d o 195Zti 1109 'ON/00: S 'iS/ N: S l NN 0 l 6 i031,' �aVd DN I ddS dC hi I O NOdd
hiechaniekl Permit
WOOD BURNING EQIINI'
Woad stave with no
WOW combination or add -on
Factory fireplace with flue
Factory lirepiace(s) Freestanding
Wood Stove (s) Franklin, other
Brand name
m(gr•s Min., Clearances, side rear
Vi ,A 'a r r
_ Model No
flue dla.
Total
No. Kitchen exhaust - dotted rWnWadn elm
No. �.— Bath esAaust mast be eted ou Ids dko /
No. „- _ Other %ns: Loeations h��v%s )D�en.�Cn tfm o
Total
FEEL STORAGE (MUST BE APPROVED BY ME MARSHALL)
101"Hadon Regal -W
Fuel Oil XdIM . underground inside outside
LP Gas galkons
Other Sm opening —
vsr>earrr t1SE ICALCMrTldm
2Jkll State 9tatnte Yes, This Seetion Applies
The replacement of a that meets all three of the foil mbl requiremento:
1) k2aLllllit require medWiication to electrical or got service.
2) Has a tafk.Sd9t of L%ftoo or less Bijtdlftg the coat of the f xtere or appliance; and
3) Is improved, installed or replaced by the homeowner or licensed contractor.
Skip nest section; Cost of Permit S 400
State SemchWW S _so
bw In Fee S
LW-
1. 1.23% of Cmdr2d Price r or MiWMEMF®e (;�OO) 1
UO
(Contract Price)
2. gtatftteh " Add the State Bnitding Code Division
Sorc harge to each penult. Zvi
(Contract Price)
er S.SO, whichever U greater
3, (Only mail -in appikdkons) S
4. TOTAL PERMIT FEE (Add Ines 1-3 above) S,_
" CONTRACT PRICE or JOB COST means the actual or eatlasated dollar amount charged for the
permitted work including materials' labor, profit, and other Rued costa. It is the amount to be charged
to the e®stom@r for the work dose. Many materl* equipment, labor, or laatailation are fnrniaked by
the ounw, tenant, or any other party, the reamnable market value of sash items amot be added to the
estlmatei cost or contmet price for permk fee purposes. In the event there Is a dfspade osa the anaMt
8 d l9SLt l l.0S 'ON/00: S t 'iVN: S l "N0Z 0l. 6 (03A) ''bvd IVIIN i HS J0 All O WOEd
Moohaaical Permit
of the job cost, the City may regaeet the sabmissloo of a sigma eon of the actmd contract.
** The STATE SURCHARGE is .OM of the contract price under $1,000,000 or 5.60, whichever is
®renter. For valuations over $1,000,00o taU the Department of laspectlonai Services for the
i
The uunderdgned hereby applies to the City for hu mee of a Mechanical Permit, agrees to do all work
in strict accordance wlih the ordinances of the City and the regulations of the Minassots Stab Hmlding
Code, and certifies emenis njib os this appWaden are complete, true and eorreet.
Applicant's
Approv" BY
3
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