Permits - Permit# 688 - 2421 Black Lake Road - 1/1/1986w
CITY OF SPRING PARK _ APPLICATION FOR
Mechanical Permft,
GENERAL INFORMATION
'• You DaaglAagdliqechaqical pt4mit4 by mait 04 ln-PEA604 at the City oddices. Maited-in peAmitb a4Q eubjlcl to the
B! d
•g Jet# shown below.
t. Pe4m4t ea4db will be beat by 4etu4n mail the same day the application ib 4eetived. PERMITS ARE NOT VALID UNTIL VOU
RECEIVE A PERMIT CARD. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE.
!, Whln any new C0114t4uetion 04 4emodeling ib involved, a 6epa4ata building pe4mit mubt be obtained.
e. All wo4b gust be dope in 4eco4dance with State Suit ding Code 4equiaements.
S: All wo4h mubt be inspected (tough -in and dimatl. Cott e13-7351 11-hou4 notice 4equi4ed.'0
6. Houbt Heating Tabt Reeo4d must be submitted bedo4e dinal - bte attached.
INSTRUCTIONS ComPtett all items on this application. Compute
INCOMPLETE APPLICATIONS the pe4mit doe. Sign and data the ceatidicatioq.
WILL NOT BE PROCESSED._ Td you have questions, call 413-7a61
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JOB SITE 2y zi Slack Zemke
Ppgd_ S�/r;
n4�9�k /71/V 55-31N
Occupancy Types I'LL 4e6identiat eommtnciat; Othe4
Owner's Name TGlovncS ►e La fc4avkq
Telephone Number
Mailing Address 2Cr21 ,Black LaGC•e �X•
;. ;,
Contractor's Name' Sr, ki,P
Telephone Number S4,"e
Mailing Address Sgp-1
MINIMUM FFE ($20.00 per project)
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$15.0Geach unit
'- FUEL net- gas, IP goat _ oil, elect.
other (specify if combination burnor)
EQUIP. (if more than 1 unit per bldg., list each separately)
NO. Type Stuh Input Brand Name Model No.
f . a. furnace -1,45--,Q
60 0 rCe CIO 4"ey $0 G YU75EV
hw boiler
unit heater
solar htg.
_ equipment
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M-Wench system Total'.,]
AIR CONDITIONING
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$15.00 each unit
_ Central Air Separate Central Air System
w/furnace
Brand Name Model No. Tons
Total
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y�1�1.�11f each Unit_ Wood stave with flue
Factory Fireplace(s) _ freestanding _ built-in
$ 30.00 each unit flood combination.or add -on Unit,
t-
wood Stove(s) ` franklin, other
$ 15.00 each unit factory fireplace with flue
Brand Name Model No.
Mfgr'a Min. Clearances, side , rear Min. Flue Dia.
Total
-
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No. _ Kitchen Exhaust _ ducted recirculating cfm
8 3.00 each exhaust fans (bath,°kitchen,
attic, etc.)
No. r Bath Exhaust (must be ducted outside) _ cfm
NO. _ Other Fans: Locations cfm
Total
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PUILL STo sea (must be approved by fire marshal)
_ Fuel oil, i gallons underground __ inside _ outside
Lp Gas, gallons
Other,
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. SPRINKLER cYATEKg _ ($20.00 minimum; $100.00 maximum)
a) Residential' $20.00
Number of Heads _ No. of Risers _
b) Commercial $29.00 Plan Review
Type of System (1 sots of plans required for review)
$2.00 per head Total
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Commercial, Industrial 6 Multi -Family seo Fee Schedule
PERMIT FEE CALCULATION
1.
Total
of above Installations or Minimum Fee ($20.00)
$ Q, 00..
2.
State
Surcharge Add the State Building Code Division Su4cha4gt to each pe4mit
$ .50
3.
Postage
and Handling On all mailed -in applications, add the pobtage and handling Jet
$
4.
TOTAL
PERMIT FEE add tineb 1-1 above
he undt%iigged he4eby apptieb to the City of 04on0 dot ibsuance of a Mechanical Pe4mit, agates to do all wo4h in •t4ict
,co+danet with the d4diaanceb of the City and tilt 4e9ut4ti0ns od the Minnesota State Building Code. and ee4ti6ieb that
?t etatemtnts made on this application a4e complete, t4ut and c044act.
Form No. 294
Wler-nay co.,
$ so 50No. 688
State of. Minnesota, f Spring Park
- u
County of Uguagpia Office of Building Inspector
)Mechanical Permit
IN CONSIDERATION OF The statements made by T''maS R. Latehcharu
in application therefor duly filed in this office, which application is hereby made a part hereof,
PERMISSION IS HEREBY GRANTED To -said Thomas Latcham as owner
to insta-31 gas furnace
upon that tract of land described as follows: Lot Block __; plat or addition
Address 'JA23 flack Lake Road
which tract is of the size and area specified in said application.
This permit is granted upon the express conditions that said owner and h— contractors, agents, workers
and employees, shall. comply in all respects with the ordinances of the City. . i Spring Panic
State of Hinnacnta
Given under the hand of the Building Inspector n —of said _ Cit.y and its corporate
seal and attested by its Clerk this 2nd day of October 19
Attest
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