Permits - Permit# 04-05M - 2421 Black Lake Road - 1/1/20044FROM CITY OF SPRING PARK (FRI)12 13 2002 13:07/ST.13A6/N0.5011475261 P 1
K
CITY O)P' SPRING PARK
4349 WARREN AVENUE
SPRING PARK, MINNESOTA 55384
"2-471-"51
APPLICATION FOR MECHANICAL PERMIT
1. You may apply for dal permits by nab or In person at the City olrwes. Appileatiess will be
reviewed and a per" will be lamed witQb 2 working days.
2. Fa®t cards will be no by return mail after a review f4 completed. PFJLMZTS ARE NOT VALID
Uran YOU RECEIVE A PERMIT. -teaM � �" NQT =0 1131M 9fD8PERMfr CARD ac
3. - Complete calculations, detailsand slimilkations are negn ed for each
healing, vestilsdou, 6amidific - -offildification, and air condidesing bsstallad0d IDtfudiult beat
loss&eat gals calculation, awigs temperatures, eqdpmvd rsfiW and tdesti leation as to type,
manufacturer and model. Data shalt be presented on farm provided. Identification of and
sped&stfous for water beating equipment shall also be provided.
4. Wbes any new constructionor remadeft is bmhe4 a mPmtt bGildMg perealt unfit be obtained.
S. A® work wort be done is accordance wi49 the UmfM l Oebsm Cal CodeiState BuRdleg Code
ruts.
6. All work must be bgwcud (rag" and 1m1). Can 952.2494600. A 24 bow notice Is rtgWirG .
7. House Heats" Test Vim" ss 0 be before fflaal.
INM3111MMS Complete all WHO oa lob sPPHcatI. C mPEte the permit tom. Sip and daft the
eerdricati. INCOMPLETE APPLICATIONS WELL NOT 8Z PROCESSED. H you Dave
call 952-249.4600 or 952.471-W.1.
]Please check ore: New Addidom Repair Replace
ResidentialCommercial
JOB SUE yZl - �30�
Owner's Nano �— 2 5 Pbone Number
Malting Address
Comtractor'sl4ame �z, - . PhvaeNumber biz-'z4
Mf `i
aw Addre" 1 it c. • E Ll 1 S _ S ; ., . ; A
SYSTEM D1tSCREMAN
HEATING SYSTEMS
Quantity --
Make
Nam
ftel Ng•r . G� 5
Flue Sire a _.--
Input xTUs v • o v
061pin BTUs
CIPM
COOLING SYSTUIS
Quantfty
IblAke
Model i «
TansH. Power —
4ROM CITY OF SPRING PARK (FRI)12 13 2002 13:07/ST.13:06/NO.5011475261 P 2
Wcbanical Permit
WOOD BURNMG EQUEPNON'1'
Wood stove with flue
Wood combination or add -an —
Fbctm arepiate with floe
Factory e(s) Freestanding
Masonry
wood Stove (s)
Brad
made] No
oam
Mfgr's Mtn., Cle.reacm side rear
mire. (lire dia. _
Total
VENTR AT1ON do
�—
No. Kitch" eahanet - ducted recirculating
No. Bath esh=a (age be dated outt"e) Chu
Ne. OUrer fees- L9catlms TOW)
tes _
FUEL STORAGE "T BS ApPROVXV BY FIRE MAR.SHAl.1.)
Fuel Oil floss inside ouWide
p
LIP (Cas tallass
Other gm opening
PXRM ELI ILI (`U A33QM
Iles, This Section Applies
The replacesaewt of a R-� esdal XWre or MppUfi= tbst meets all tbree dthe (otioariap ragou ts.
1) DUMUM ire MwdrwAdon to d ectrieal or pas so vices
2) UM a IgIWLC m[ of SM0.00 or less cmhuUft the cost of the Aaedre or appliaoee: and
3) Ia improved, iastafied or replaced by the homeowner or lkvuWd ooaractor.
Skip seat socdoa; Cost of Permit $
SISM
State surcharge S so -
Man in Fee $
1. 1.25% of CoftoMM -Or ux:"aw°"w'
'277 O a .b12S
(Contract r'fice)
2. •O Add the Stab lkdM t Code
Sumbarge to each person. 1.0005
(Contract mike)
or SM, wbkhever is greater
3, (0* 1Oai148 appiicsdons)
4. TOTAL PERMTr M (Add lines 1-3 above)
s P1• 8� Y is6oi73.3f
S two
s IgO-zb
• CONTRACT PRICE or JOB COST meats the aetud or estlmated doeiar apt charged for the
pergd#ed work inelp"g, aortal:, labor, Profit, and other fttd costs. It is the amou®t to be charged
to the for the worst done. N anymatutgk ems6 heor, or houdtatron are famished by
the owner, tenasrt, or any other peaty, the reasonable wm*et vane of such stems must be added to the
estimated cost or coatraet price for permit be purposm m the event there is a dispute on the amount
FROM CITY OF SPRING PARK (FRI)12 13 2002 13;07/ST.13:06/N0.5011475261 P 3
MMIMI ical Petsut
of the job cost, the City may request the submission of it dgaed copy of the actoai contract.
•" The STATE S>URCBARGE is U80S of the costmet price under $I NO,OW orS.So, whichever k
greater. For valuations over $1,000,000 call Me DepartmM of iaspeed"d Services for the
price.
The rsderdped hereby appbes to the City for bmmce of a Mechanical Perok, sprees to do all work
is strict aceordaaee with 64W&Aaneex or the City t reavlatim or the Mhoesotn State Building
Code, and certilles that allle7sma
tde on t6' i are complete, true and correct.
Applicant's Slpasttre
4
Approved By
Date