Permits - Permit# 05-04M - 2424 Black Lake Road - 1/1/2005.V4
CITY OF SPRING PARK
4349 WARREN AVENUE
SPRING PARK, MINNESOTA . 55384
952-471-9051
APPLICATION FOR MECHANICAL PERMIT
GENERAL INFORMATION
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 BEGIN UNTIL. THE PEILMEE CARD IS
POSTED ON THE JOB SITE.
3. Mechanical Designs - Complete calculations, details and specifications are required for each
heating, ventilation, humidification -dehumidification, and air conditioning installation including heat
loss/heat gain calculation, design temperatures, equipment ratings and identification 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 construction or remodeling is involved, a separate building permit must 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 952-249-4600. A 24 hour notice is required.
7. House Heating Test Record must be submitted before final.
INSTRUCTIONS Complete all items on this application. Compute the permit fee. 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 / Repair Replace
Residential V Commercial
JOB SITE 2- L{ Z. L( '� I c, c. IC L V . 1k
Owner's Name rlvo A S Phone Number.
Mailing Address Z LA Z L1 A
Contractor's Name Phone Number
Mailing Address
HEATING SYSTEMS
Quantity
Make
Model
i U�
calz- 06 G
Fuel
a'r 4 S
Flue Size
;n.
Input BTUs
Ud(�
Output BTUs
OO
CFM
,00
COOLING SYSTEMS
Quantity
Make ► Su vl
Model . .� -(901z
Tons
H. Power -As-
Mechanical Permit
WOOD BURNING EQUIPMENT
Wood stove with flue
Wood combination or add -on
Factory fireplace with flue
Factory fireplace(s) Freestanding Masonry
Wood Stove (s) Franklin, other
Brand name eb ;] eh'f- � S-e-7A c Model Nq 9 I/ Ll
Mfgr's Min., Clearances, side 0 rear -¢ min. flue dia. y
Total
VENTILATION
No. Kitchen exhaust - ducted recirculating
No. �_ Bath exhaust (must be ducted outside)
No. Other fans: Locations
FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHALL)
Installation Removal
Fuel Oil gallons underground inside outside
LP Gas gallons
Other
PERMIT FEE CALCULATION(S)
2002 State Statute _ _, Yes, This Section Applies
Total
gas opening
cfm
cfm _S3 0
cfm
O
The replacement of a Residential fixture or appliance that meets all three of the following requirements:
1) Does not require modification to electrical or gas service.
2) Has a total cost of $500.00 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 $ $15.00
State Surcharge $ .50
Mail In Fee $ 1.50
1. 1.25% of Contract Price * or Minimum Fee ($35,00)
'29 )O, w x .0125
(Contract Price)
2. State Surcharge ** Add the State Building Code Division
Surcharge to each permit. �gCjj . x .0005
(Contract Price)
or $.50, whichever is greater
3. Postage and Handling (Only mail -in applications)
4. TOTAL PERMIT FEE (Add lines 1-3 above)
3 §Gv
* 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 must be added to the
estimated cost or contract price for permit fee purposes. In the event there is a dispute on the amount
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Mechanical Permit
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 $.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 (IdV S
Approved By Date