Permits - Permit# 05-11P - 2425 Black Lake Road - 1/1/2005CITY OF SPRING PARK
4349 WARREN AVENUE
SPRING PARK, MINNESOTA 55384
952-471-9051
APPLICATION FOR PLUMBING PERMIT
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City offices. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT
CARD IS POSTED ON THE JOB SITE,
3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property owners
residing in the dwelling.
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 State Code requirements.
6. All work must be inspected and air tested before it is covered. Call 952-2494600. A 24-hour notice
required.
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
952-2494600.
Please check one: New Addition Repair Replace
Residential -;�, Commercial
JOB SITE:
Owner's Name _
Mailing Address '
Contractor's Name
Mailing Address _
FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER
TYPE FL FL TYPE EL EL
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NE�t for
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P-114-M IT6 , ,
Plumbing Pemnit Application
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2002 State Statute Yes, This Section Applies
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;
If above does not apply, follow guidelines below:
Cost of Permit S 15.00
State Surcharge S .50
Mail In Fee S 1.50
1. 1.25% Of Contract Price* or Minimum Fee ($35.00)
.0125
Contract Price
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit x .0005
Contract Price
or $.50, whichever is greater
3. Postage and Handling
4. TOTAL PERMIT FEE
(Only mail -in applications)
(Add lines 1-3 above)
S` ,
S ,
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 must be added to the
estimated cost or contract price for the permit fee purposes. In the event that there is a dispute on the
amount 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 Plumbing Permit, agrees to do all work in strict
accordance with the ordinainces of the City and the regulations of the State of Minnesota, and certifies that
all statements made on this application are complete, true and correct.
Applicant's Signature Date ��]D
2
Form No.284 Valuation $600.00
Permit 1XXXXXXX U 03 $35
$ State XXXI(X'1(Ii�XXXXXX XX . . 98
TOTAL %X==)$XXi)pX)0)0X $35.50
State of Minnesota,
JJ.
County of Hennepin
Election Systems and Sollware l-800.800-8225
No.
City of Spring. Park
05-11 P
Officeof Building Inspector
Plumbing Permit
IN CONSIDERATION OF The statements made by
Tonka Plumbing & Heating/Larry Schussler
in their application therefor duly filed in this office, which application is hereby made a part hereof,
PERMISSION IS HEREBY GRANTED To said Tonka Plumbing & Heating/Larry Schussler as owner
to Misc. water piping -water closet lavatory
upon that tract of land described as follows: Lot Block plat or addition
Address 2425 Black 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 of Spring Park
Given under the hand of the Building Inspector of said City and its corporate
seal and attested by its C1 e r k this 12th day of December Year 2005
Attest: �,
William D. W �. Weeks ��
Clerk Building ect
MINNESOTA DEPARTMENT OF LABOR AND INDUSTRY - BOND CERTIFICATE
This is to certify that Scott B. Frovarp, Master Plumber License No. PM005688,
I
representing Tonka Plumbing Heating & Cooling Inc., has filed a $25,000 bond
with the Commissioner of Labor and Industry on November 17, 2005 for the year
2006 in accordance with the provisions of Minnesota Statutes, Section 326.40.
BOND NO. 93 J4 6807-7
State Farm Fire & Casualty
Bloomington, Illinois
MR SCOTT B FROVARP
TONKA PLUMBING HEATING & COOLING INC.
265 COUNTY ROAD 110 NORTH
MOUND MN 55364-8317 Scott Brener, Commissioner_
2006
6tarte of ftltnnegota
Alinnegota meparfiwnt of ' EA r anb Nbusup
PLUMBING UNIT
443 LAFAYETTE ROAD NORTH, ST. PAUL, MN 55155-4343
Master Plumber License
LICENSE NO 005688PM
Scott B. Frovarp
8709 Hillview Drive East
Saint Bonifacius, MN 55375
EFFECTIVE DATE
01/01/2006
EXPIRATION DATE
12/31/2006
Dbc-12-05 01:57P Roger G Finnes 952 472 62613 P.02
CERTIFICATE OF INSURANCE
Thi TI
STATE FARM FIRE AND CASUALTY COMPANY, Bloomington. Illinois
STATE FARM GENERAL INSURANCE COMPANY. Bloomington, Illinois
STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven. Florida
❑ STATE FARM LLOYDS, Dallas. Texas
insures the following policyholder for the coverages indicated below:
Name of policyholder TONKA PLUMRTNG HENfING AND COOLING INC
Address of policyholder 265 CTY Rn 110 N HOUND MN 55364
Location of operations MINNESOTA
Description of operations PLUMBING, JILATTNG AND COOLING
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date : ExpiraW, Della (at beginning of policy period)
93-K•1'-0495-6 t• Comprehensive 05/OB/7005 05/00/2006 BODILY INJURY AND
Business Liability --- PROPERTY DAMAGE
.. •........................ ---...------------------ --
This insurance includes: ® Products - Completed Operations
❑ Contractual Liability
❑ Underground Hazard Coverage Each Occurrence $ 500, 000
❑ Personal Injury
(] Advertising Injury General Aggregate $ 1,0o0,000
❑ Explosion Hazard Coverage
❑ Collapse Hazard Coverage Products - Completed $ 1, 000, 000
❑ Operations Aggregate
POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effective Data ; Expiration Oft (Combined Single Limit)
❑ Umbrella Each Occurrence $
❑ Other Aggregate $
Part 1 STATUTORY
Part 2 BODILY INJURY
93-KT-0495 6 WORKERS COMP 06/15/2005 06/15/2005 Each Accident $ 50o, 000
Disease Each Employee $ 500, 000
Disease - Policy Limit $ 500, 000
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective DAM ; Expiration Dale (at beginning of policy period)
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
If any of the described policies are canceled before
its expiration date, State Farm will try to mail a written
notice to the Certificate holder 30 days before
Name and Address of Certificate Holder ncan.owever, we fail to mail such notice,
liability will be imposed on State
Acidi1.iiirt31 7nq��rc cl s Or 1811Ves.
C'TTY Ol' SE'RTNG PARK:;PHING PARK,MN 55384 Representative
gent 12/12/2005
Title Date
Agents Code Stamp
ROGER G. FINNE1s, C.P.C.U., AM
STATE FARM INW WM-UC. #IW3051
sWsea a a 04-1 goo Printed in U.S.A. 4W1 SHORELINE DRIVE-p.0. =153
r��ur,�Me� MOt1ND. MINNESOTA 55364
PHONE. (952) 472-5W