Permits - Permit# 03-17M - 2421 Black Lake Road - 1/1/2003CITY OF SPRING PARK
4349 WARREN AVENUE
SPRING PARK, MINNESOTA 55384
952471-9051
APPLICATION FOR MECHANICAL PERMIT
GENERAL 0WORMATION
1. You may apply for mechanical permits by mail or in person at the City offices. Applications will be
reviewed and a permit will be issued within 2 working days.
2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT VALID
UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT RECHN UNIM, THE PERMIT CARD LS
PO4TF_D ON THE JOB SITE,
3. Mechxn*rskI DeQQa. - Complete calculations, details and specifications are required for each
heating, ventilation, humidification-debumldiflcation, and air conditioning Installation including heat
loss/beat gain calculation, design temperatures, equipment ratings and identification as to type,
manufacturer and model. Data shall be presented on form provided. Identification of and
specltleatious for water beating equipment shall also be provided.
4. When any new construction or remodeling Is Involved, a separate building permit roust be obtained.
5. All work must be done In accordance with the Uniform Mechanical Code/State Building Code
requirements.
6. All work must be Inspected (rough -in and final). Call 952-2494600. A 24 hoar notice Is required.
7. House Heating Test Record must be submitted before final.
INSTRIJ .TIO S Complete all items on this application. Compute the permit fm Sign and date the
certification. iNCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions,
call 952-249-4600 or 952-471-9051.
Please check one: New Addition -Pf_ Repair Replace
Residential Z Commerclal
JOB SPIE_
Owner's Name _
Mailing Address
Contractor's Nag
Mailing Address
SYSTEM DESCRIPTION
SEATING SYSTEMS
Quantity
Make
Model
Fuel
Flue Size
Input BTUs
Output BTUs
CFM
COOLING SYSTEMS
Quantity
Make
Model
Tons
H. Power
Number
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Mechanical Permit
WOOD BURNING EQUIPMENT
Wood stove with flue
Wood combination or add -on
Factory fireplace with Rue
Factory fireplace(s) �� Freestanding Masonry
Wood Stove (s) Franklin, other
Brand name rym;l'4ic— Model No d(2 36 RFy
Mfgr's Min., Clearances, side rear min. flue dia.
Total
VENTR ATION
No. Kitchen exhaust - ducted recirculating cfm
No. Bath exhaust (must be ducted outside) cfm
No. Other fans: Locations cfm
Total
FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHALL)
Installation Removal
Fuel Oil gallons underground inside outside
LP Gas gallons
Other gas opening
PERAUT EEE CA .0 I .ATION(S)
2002 State S y *+p Yes, This Section Applies
The replacement of a Reaids-intmal fixture or anniiance that meets all three of the following requirements:
1) Dim not require modification to electrical or gas service.
2) Has a tnW cost of S500.00 or less excluding the cost of the fixture or appliance; and
3) Is improved, installed or replaced by the homeowner or licensed contractor.
Skip next section; Cost of Permit S 515.00
State Surcharge S _SO
Mall In Fee $ 1_59
35 �5
1. 1.25% of Contract Price • or
rSp.CP x.0125 S 33,)5
(Contract Price) i'-
2. State qurcha= •* Add the State Building Code Division
Surcharge to each permit. 'j (Q7 :.0005 f ( 35
(Contract Price)
or $.SO, whichever Is greater
3. Postage mmd Handling, (Only mail -in applications) S 1-50
4. TOTAL PERMIT FEE (Add lines 1-3 above) S
CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
permitted work including materials, labor, profit, and other fixed costs. It Is the amount to be charged
to the customer for the work done. If any material, equipment, labor, or Installation are furnished by
the owner, tenant, or any other party, the reasonable market value of such items most be added to the
estimated cost or contract price for permit fee purposes. In the event there is a dispute on the amount
£OOZ 91 6 (NOW) `AVA to i uac Jn A i i) Itl(1WJ
MechaniW Pemik
of the job cost, the City may request the submission of a signed copy of the actual contract.
*" The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or S.50, whichever is
greater. For valuations over $1,000,000 call the Department of Inspectional Services for the
price.
The undersigned hereby applies to the City for Issuance of a Mechanical Permit, agrees to do all work
in strict accordance with the ordinances of the City and the regulations of the Minnesota State Building
Code, and certifies that all statements made on this application are complete, true and correct.
Applicant's Signature Date
Approved By Date
3
b £OOZ 5 l 6 (NOW) ;laud 9N I Mr R �0 AM WOH4