Permits - Permit# 05-01M - 2421 Black Lake Road - 1/1/2005FROM CITY OF SPRING PARK (MON) 4 5 2004 14:55/ST.14:55/NO.5011475914 P 1
�-S " a i 1-77
CrFV OF SPRING PARK
4349 WARREN AVENUE
SPRING PARK, MINNESOTA 55384
"2 471-9051
APPLICATION FOR MECHANICAL PERMIT
IfAIM
1. You may apply for mechanical permits by malt or in persoe at the City Offie . Applications will be
reviewed and a perms will be issued within 2 working days.
2. Permit cards will be seat by return mail after a review is completed. PERMITS ARM NOT VALID
UNTIL YOU RECEIVE A PERMIT.
POS'f'ED_ON In JOB SITE.
3. - Complete calculations, details and specHicatioos are negitined ror cub
heating, ventilation, buinNlication-debwmldlticadon, and air conditioning installation including beat
losw%eat gain calcolatton, design temperatures, equipment ratings and idmilfication as to type,
manufacturer and model. Data shall be presented on form provided. Identification of and
specifications for water heating equipment shall also be provided.
4. When any new coastructlea or remodeling is involved, a separate broldi ig permit wall be obtained.
S. 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 952-2494M. A 24 hoar notice is required.
7. Rome ®eating Test Record a" be emitted before final.
jHWMH=pN5 Complete all items on this application_ Cam" the permit fee. Sign and date the
certification. ENCOMPLETE APPLICATIONS WELL NOT BE PROCESSED. If you have ems,
call 952-249-4600 or 952471-9051.
Please cbeck one: New _,-,g.,�-Addidon Repair Replace
Residential _ I Coasasercial
JOB Sl E•E &'
Owner's Name _
Mailing Address
Contractor's Name
Maili ft Address J
i•A
HEATING SYSTEMS
Quantity
Make
Model
Fuel
Pho Size
input BTUs
Output $TUB
CFM
COOLING SYSTEMS
Quandly
Make
Model
Tons
H. Power
a rv: IS
+-i 1
Number
-Tt
Number - - 16 `i Cl
i-1-(1-V,.- Lt-t4-1iSO
FROM CITY OF SPRING PARK (MON) 4 5 2004 14:55/ST.14:55/N0.5O11475914 P 3
Mcchaniml Permit
of the job coat, the City may request the submission of a ataned copy of the actual contract.
ww The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.SO, wbkbever 1a
greater. For valuations over $1,0O0,000 call the Department of Inspectlonal Services for the
price.
The undersiped hereby a 11 to the City for issuance a Mechanical PensK Wees to do all work
In strict aceordame, with the anees of the CUM and repaiattona of the Minnesom State Building
Code, and certafles that all state tr
is made on appl are complete, true and correct.
Applicant's Sipahwe v v Due —
Approved By Date
3
FROM CITY OF SPRING PARK (MON) 4 5 2004 14:55/ST.14:55/NO.5011475914 P 2
Mechanical PcnWt
WOOD BURNMG EQUIPl16M
Wood stave with an
Wood combination or fill -on
Factory BrepWe with flee
Factory Areplace(s) Frees Masonry
wood Stove (s) Fanld % other
Brand name Model No
Mtgr's Mla., Clearances, side rear min. flue dim.
Total
► 35iI a i Ll
No. Kitchen exhaust - dotted recirculating of n
No. Bath eaha ust (must be ducted outside) efm
No. Other (aus: Locations efm
TOW
FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHALL)
Installation Removal!
Fwl Oil gams underground Inside outside
LP Gas 91101002
Other Sus opening
2002 State Statute Yes, This Sects Applies
The replacement of a that ■fleets all three of the following requuiremeaM
1) RuLaad require modification to electrical or gas service
2) Has a falal cW of SM.00 or less achuft the CON of the fixture or apptiaace; and
3) le improved, installed or replaced by the homeowner or licensed contractor.
Skip next section; Cost of permit $
State Surcharge S _%
Mail is Fee S Im
1. 1.25% of ContradjWm * or Minims Fee (S") O
=rJ12 x.0125 S
(Casotract Price) —
2. State Surchanc ** Add the State Building Code Division _ t o
Surcharge to each persdt. _ -ems S
(Contract Price)
or S.SO, whichever is greater
3. Embp and Hmdft (Only meuil-ie Applications) i i SII
4. TOTAL PERwT FEE (Add lister 1-3 above) S. '3'7 - 6 0
CONTRACT PRICE or JOB COST mans the actual or estimated dollar amount charged for the
permitted work Including materials, labor, profit, and other flared costs. It is the amount to be charged
to the customer for the worts done. H any material, equipiment, labor, or hatalladon, are furnished by
the owner, tenant or any other party, the reasonable market value of such Items must be added to the
estimated cost or contraeet price for permit fee purpom in the event there Is a dispute on Me amount