Permits - Permit# SP18-39 - 2425 Black Lake Road - 1/1/2018CITY OF SPRING PARK
PAGE 1 BUILDING PERMIT
4349 Warren Avenue
Handout Given �/� ,
Spring Park, MN 55384
Phone: 952-471-9051 Fax: 952-471-9160
Lead Handout Given
�J4Q S C � �A.C�
p �❑ �j n ? r
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SITE ADDRESS: loza
PID:1 /
1) Was the home constructed before 1978? (YES o, continue with
line 2, NO o continue without completing EPA Section)
2) Will the work disturb z6 sq ft of interior painted surfaces or 2:20 sq ft of exterior painted surfaces? (YES ❑ go to line 4, NO ❑ line 3)
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3) Are there any windows being replaced? (YES n, go to line 4, NO ❑ continue without completing EPA Section)
4) Has this home been Certified Lead Free? (YES o, you MUST Attach Certification Information, NO o complete line 5)
5) EPA Contractor Certification Number: NAT -
(applies to contractor only)
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PROPERTY OWNER: rt SGS C F_
Address: `•y 2 cx r R.1D
City: i4gLM5 10= State: Zip: I9
Email:
Contact Name:
Phone:
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CONTRACTOR: Li J6+Jie =4DD AVDrAddress:
) ! e NE
Cif P State: Zip:
Phone: - ,3 - 060 8 Fax:'7 6 3 7) SS
Contractor License No: MISM03598
Contact Name: DAfiftl Phone% - O$D
Email: r C .
e
ARCHITECT:
Address:
City: State: Zip:
Phone: Fax:
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Email:
Contact Name: Phone:
TYPE OF WORK: ❑ New Construction
o Deck ❑ Re -Roof
o Commercial ,Residential ❑ Change of Use
❑ Pool ❑ Re -Side
EST. VALUATION OF WORK o Finish Basement
❑ Retaining Wall ❑ Fence
$ ❑ Remodel
❑ Porch ❑ Shed
Square feet: nAddition
❑ Demolition ❑ Window/Door Replacement
n Garage-Attached/Detach n Plumbing -provide detail on Page 2 # being replaced
Detailed Description of Work: ❑ Accessory Structure
echanical-provide detail on Page 2 ❑ Misc Other
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Signature of this application by the legal property owner or a licensed contractor, as the owner's represenmWe, is required and authorizes the Zoning Administrator or designee and the Bulking Official
designee to enter upon the property to perform needed inspections. Entry may be without prior notice. I hereby acknowledge that I have read this applicalion and state that all information Is true and
corract to the hest of my knowledge. I further agree that aN work performed will be in accordance with approved plans, specifications and conditions and to abide by all ordinances of the Municipality
nd the laws of the State of Minnesota regarding actions taken pursuant to this permit. 1 agree to pay all plan review fees even If I choose not to proceed with the work. Permit expires when work
is not commenced within 180 days from date of permit, or if works suspended, abandoned or
not Inspected for 180 days. Work beyond the scope of this permit or work without a permit or inspection,
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1 be subject to a penalty.
Noise Ordinance In Effect: MONDAY - FRIDAY Before 7 a.m.
and after 10 p.m. Weekends/Holidays before 7 a.m. and after 8 p.m.
SIGNATURE OF APPLICANT:
DATE: %bh-74/ S
PRINTED NAME:
This is the signature of: ❑ Owner or o Owner's Representative
OCCUP. TYPE: CONST. TYPE: CODE:
BLDG SPRINKLED Yes I No
VALUATION: $
Permit Fee: $
WAC Charge: $
Plan Review Fee: $
Sewer & Water Hook -Up: $
State Surcharge: $
Sewer 8 Water Disconnect: $
Site Inspection Fee: $
Water Meter: $
S.E.C. Fee: $
Muni SE -MA Fee:
Investigation Fee / Other Fee: $
°2016 SAC Escro . $2.485
y
Copy Charge ($.25 per 8.5 x11 pagey $
Ot er: $
0
License Check ($5) / Lead Check ($5) $
VIA
TOTAL D E: $
-TOTAL $
as
�SUB
Plumbing Fee (from Page 2) $
140TE: Commercial plans will be subm' to the Met Council Environmental
for SAC determination. Escrow payment wit aired when permit is fss
U
Mechanical Fee from Page 2 $ /
after Mot Council review no SAC is determined, escrow wI r nded in full.
LL
Special Conditions/Required Setbacks:
LL
O
Building Approval By:
DATE:
Printed Building Approval By:
❑ License Verification ❑ Lead Verification - Checked By:
City Approval By:
DATE:
Paid: S DD Date: Receipt No.
73 By:
I
CITY OF SPRING PARK ❑ MECHANICAL PERMIT
i ❑ PLUMBING PERMIT
PAGE 2 i FOR PERMIT ISSUANCE
I PAGE 1 and PAGE 2 should be complete
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Mechanical Contractor: L 44C IAuLf TAIC Address: ) 5J;J`y LLW e 11JE
C 5,1[ L State: d 'zip: Phone: JZ• Fax: 3- 3 a - 'r $
State Bond No: f4bD $
Contact Name: r ' n
Email:
Contact Phone: - cj
Detailed Description of Work: 54 Irn Air jn l
e
— r
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
uanity 0-yanity I Quanity
Furnace Kitchen Fan Furnace
Air ConditioningSystem
y stem 3 Bath Fan k / Fireplace
Air Exchanger Grill Unit Heater
Fireplace _� i �fq el Vult Water Heater
Unit Heater i 0 Grill
In Floor Heat fJr / Dryer
Gas Log JY Stove
❑ Replacement (one fixture only, no piping or vent changes)
Office Use Only:
Mechanical Permit Fee: $
(Addition/Remodel I
''❑``New
Gas Line Permit Fee: $ 0 —
Construction
State Surcharge: $ / —
❑ Other '
Other: $ --
Total Mechanical Permit: $ S
DiM ®' 6
P BIN
Plumbing Contractor: Address:
City: State: Zip: Phone: Fax:
Plumbers License No:
IState Bond No:
Contact Name:
Contact Phone:
Email:
Detailed Description of Work:
I
I
Indicate type of project and fixtures you will be installing or replacing (include count for each type of fixture):
PLUMBING FIXTURES
Quanity Quanity I Quanity
Water Heater Shower Laundry Tub
❑ Gas ❑ Electric Dishwasher Rough -In Future Fixture
Water Softener Clothes Washer Sump
Lawn Sprinkler System Ice Maker Line Water Piping System
Water Closet (Toilet) Hose Bib Floor Drain
Lavatory Wash Basin Bathtub
Office Use Ordy:
❑ Replacement (one fixture only, no piping or vent changes)
Plumbing Permit Fee: $
❑ Addition/Remodel
State Surcharge $
❑ New Construction
Other: $
❑ Other
Total Plumbing Permit: $
IF I
LICENSE/CERTIFICATE/REGISTRATION DETAIL
MECHANICAL
Class Type:
CONTRACTOR
Number:
MB003598
BOND
Application
120660
Status:
ISSUED
No:
Effect
Expire Date:
9/24/2020
9/25/2018
Date:
Print
Orig Date:
9/18/2009
9/24/2018
Date:
Enforcement
NO
Action:
Workplace
N/A
Experience:
Name: LITTLE IGLOO HEATING & AIR CONDITIONING INC
Address: 2132 152ND LN NE
ANDOVER, MN 55304
Phone: 612-636-0500
Business Relationship Requirements
Name: Lic/Reg No:
Status: Application No:
Expire Date: Effect Date:
Orig Date:
Another Lookup?
-THIS CARD MUST BE VISIBLY POSTED, CITY of SPRING PARK Permit #
ACCESSIBLE, AND PROTECTED FROM
WEATHER AND PHYSICAL DAMAGE PERMIT CARD S P 18-039
FOR THE DURATION OF THIS PERMIT.
(VALID FOR A SINGLE PROJECT)
Site Address: ��a ��� �- e Building: 1'eSic +cam
Owner Name: 1M.Ayk 4, J-65) CA(A
Contractor Name:
Contractor License: M8 001._36_4ly Date Issued: I/ d P-3
REFER TO HANDOUT FOR INSPECTION REQUIREMENTS
OFFICE USE
❑ ROOFING
❑ SIDING 0
WINDOW ❑ DOOR
HANDOUT
INSPECTOR:
DATE:
n
Issued by: F:j Received by: /!/�.�.Y
❑ FENCE Q
SHED
Front: Back:
INSPECTION:
DATE:
Side: Side:
MECHANICAL
❑ FIREPLACE
n PLUMBING
COMMENT
_ROUGH -IN:
DATE:
Pressure test for plumbing and hydronic piping
,GAS LINE:
DATE:
Air test reauired for new gas line
FINAL:
DATE:
Gas line fitting test required
MUST CALL TO SCHEDULE NO LATER THAN THE BUSINESS DAY PRIOR TO THE INSPECTION DAY
Permit will expire 180 days after issuance. All work must comply with the MN State Building Code.
PHONE (952) 442-7520 MNSPECT, LLC TOLL FREE (888) 446-1801