Permits - Permit# SP18-037 - 2425 Black Lake Road - 1/1/2018CITY OF SPRING PARK BUILDING PERMIT
PAGE I
4349 Warren Avenue )(Handout Given 3`7
Spring Park, MN 55384
Phone: 952-471-9051 Fax: 952-471-9160 0 Lead Handout Given
.41- 0
SITE
........ ...
A N .. -
011
111R
PCOXF
E M3
R INIV1§1., 1� i
'Y
CONTRACTOR: -v Al c- Address: (0AC3
City: Sk - KAiCi-ta P State: jZip: 13- Phone: '7ip2 9 15-1 — Fax:
Contractor License No: Ryl DC -A 7S-T- Contact Name: V_ry-i: Phone:
Email:
ARCHITECT: Address:
City: State: Zip: Phone: Fax:
•
Email: Contact Name: Phone:
....
.......
30.'
. . . . ......
W' VV-
.2
Signature of this application by the Wo property owner or a kensed contractor. as the owners represei Is required and sulhorkm the Zoning Administrator or designee and the Suliling Official
or designee to erder upon the property to perform needed inspections. Entry may be without prior notice. I hereby acknowledge 00 1 have read this application and state that of Information is true and
correct to the best at my wamedge. i further awes that al work pei wit be in accordance with approval plans. specifications end oonditione and to abide by sit ordWtances of the Municipally
and the laws of the State of Minnesota regarding actions taken pursuant to M permit. I agree to pay all plan review fees even It I choose not to proceed with the work. Permit expires when work
is not commenced within 180 days from date of permIt. or N work is suspended, abandoned, or not Inspected for 180 days. Work beyond the scope of ft pennit, or work wWwA a permit or inspection,
•
will be subject to a penalty.
Noise Ordinance In Effect: MONDAY -fPJDAY Before 7 a.m. and after 10 p.m. WeekendslHolidays before 7 a.m. and after 8 p.m.
DATIE"..7.
PRENAMES' 13.4 ve
OCCUP. TYPE: %tONST. TYPE: CODE: BLDG SPRINKLED Yes No
VALUATION: $
Permit Fee: $ WAC Charge: $
Plan Review Fee: $ Sewer& Water Hook -Up: $
State Surcharge: $ Sewer & Water Disconnect: $
Site inspection Fee: $ Meter
Muni f
S.E.C. Fee: $ 11 S=A $
Investigation Fee / Other Fee: $ *2016 SAC E w: $2,485
Copy Charge ($.25 per 8.5 x1 I page) $ her: $
.j
z
License Check ($5) / Lead Check ($5) $ TOTA DUE: $ A-
0
W
SUB -TOTAL $
W
•*NOTE: Commercial plans will be a bmifted to the Met Council Envir @8
Plumbing Fee from Page 2) $ (S - Z.A.
I for SAC determination. Escrow pa rd will be required when permit t f
W
Mechanical Fee from Page 2) $ after Met Council review no SAC Ia tenmined, escrowwillbe refunded In full.
u.
Special Conditions/Required Setbacks:
L6
0
Building Approval By. DATE:
Printed Building Approval By. 0 License Verification 0 Lead Verification - Checked By:
lCity,
Approval By. DATE:
IPaid:
(I Date: 0 11 g6 I K Receipt No.,5? q,53 By:
W
a
t�
0
0
N
N
Oi
O
N
v
n
rn
v
cl
0
E
0
CITY OF SPRING PARK ❑ MECHANICAL PERMIT
x(PLUMBING PERMIT
PAGE 2 FOR PERMIT ISSUANCE
PAGE 1 and PAGE 2 should be complete
MECHANICAL INFORMATION
Mechanical Contractor: Address:
City: State: Zi : Phone: Fax:
State Bond No:
Contact Name:
Email:
Contact Phone:
Detailed Description of Work:
Indicate type of project, fixtures, and Gas Lines you will be installing or replacing (include count for each type of fixture):
MECHANICAL FIXTURES GAS LINES
Quanity Quanityuani
Furnace Kitchen Fan Furnace
Air Conditioning System Bath Fan Fireplace
Air Exchanger Grill Unit Heater
Fireplace Water Heater
Unit Heater Grill
In Floor Heat Dryer
Gas Log Stove
ONke Use Only:
❑ Replacement (one fixture only, no piping or vent changes) Mechanical Permit Fee: $
o Addition/Remodel Gas Line Permit Fee: $
o New Construction State Surcharge: $
❑ Other Other: $
Total Mechanical Permit: $
PLUMBING INFORMATION
Plumbing Contractor. Address:
City: State: Zip: Phone: Fax:
Plumbers License No:
State Bond No:
Contact Name:
Contact Phone:
Email:
Detailed Description of Work:
Indicate type of project and fixtures you will be installing or replacing (include count for each type of fixture):
PLUMBING FIXTURES
Quanity Quanilyuani
Water Heater __L— Shower Laundry Tub
o Gas o Electric I Dishwasher Rough -In Future Fixture
Water Softener Clothes Washer Sump
Lawn Sprinkler System I Ice Maker Line Water Piping System
' . Water Closet (Toilet) i Hose Bib Floor Drain
Lavato ash Basin Bathtub
Office Use Only:
❑ Replacement (one fixture only, no piping or vent changes)
Plumbing Permit Fee: $
WAddition/Remodei
State Surcharge $
❑ New Construction
Other: $
Total Plumbing Permit: $ 7
o Other
I
iL
T
LICENSE/CERTIFICATE/REGISTRATION DETAIL
MASTER
Class Type: PLUMBER Number: PM059287
Application 75166 Status: ISSUED
No:
Effect
Expire Date:
12/31 /2018
1 /1 /2017
Date:
Print
Orig Date:
3/24/1988
10/31/2016
Date:
Enforcement
CE
MET [View
NO
Action:
Status*:
details]
Workplace
N/A
Experience:
CE status must be MET before this license
can he renewed,
Name: DALEIDEN, DENNIS M
Address: 815 KATYDID LN
ST MICHAEL, MN 55376
Phone: 763-497-2290
Another Lookup?
c
O
a
OD
r.
O
N
LO
N
a
O
IHi P�ambing
#eatIny&
Air Consfitioning
4145 MacKenzie Court NE • St. Michael, MN 55376 - 763-497-2290 •Fax: 763-497-
4263
Fax Transmittal
To: on--�kAA O
ran
J
Company:
Fax No.:
From
Daft
_q 125�iSC
pages. (Includes Cover Page)
Re:
Comments:
U
"Cletvin,q OCon ('ince 7982"
PAB&D Word General\Blank Pre -Printed Fax Transmittal
t
s.
THIS ;CARD MUST BE VISIBLY POSTED, CITY QI SPR�N,G PARK Permit #
ACCESSIBLE, AND PROTECTED FROM
WEATHER AND,PHYSICALDAMAGE PERMIT CARD SP1H-O37
FOR THE DURATION OF THIS PERMIT. . .
aS (VALID FOR A SINGLE PROJECT)
Site Address: y ���� Building:
Owner Name: M oyk- t ,jts Sj u, 0,hoa,
Contractor Name: bf Q Ply,4KbinA,y lY ' 11M
Contractor License: PYVI 02iaf-2 Date Issued: 101 a-o
REFER°:TO HANDOUT FOR INSPECTION REQUIREMENTS OFFICE USE
M ROOFING -0 SIDING WINDOW 17 DOOR HANDOUT
INSPECTOR: DATE: Issued, by: Received by'L&A4