Permits - Permit# SP18-45 - 2433 Black Lake Road - 1/1/20181-4
RECEIVED NOV 16 2018
CITY OF SPRING PARK
BUILDING PERMIT
PAGE 1
4349 Warren Avenue
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Spring Park, MN 55384
GivenPhone:
952-471-9051 Fax: 952-471-9160
Lead Handout Given
SITE ADDRESS: 2433 BLACK LAKE RD
PID: 19-117-23-12-0019
1) Was the home constructed before 1978? (YES ❑, continue with line 2, NO 16 continue without completing EPA Section)
2) Will the work disturb >_6 sq ft of interior painted surfaces or a20 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 ❑, go to line 4, NO ❑
continue without completing EPA Section)
4) Has this home been Certified Lead Free? (YES ❑, you MUST Attach
Certification Information, NO ❑ complete line 5)
5) EPA Contractor Certification Number: NAT -
(applies to contractor only)
PROPERTY OWNER: ANDY FRIELER
Address:2433 BLACK LAKE RD
City: SPRING PARK State: MN Zip: 55384
Email:
Contact Name:
Phone: 952-471-7287
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CONTRACTOR: CENTERPOINT ENERGY
Address: 6161 GOLDEN VALLEY RD
City: GODLEN VALLEY State: MN Zip: 55422
Phone:763-512-2765 Fa)783-512-2663
Contractor License No: MB003503
Contact Nam4QANN ZINKEN Phon-663-512-2765
Email: joann.zinken@CenterPointEnergy.com
ARCHITECT:
Address:
City: State: Zip:
Phone: Fax:
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Email:
Contact Name: Phone:
TYPE OF WORK: ❑ New Construction
❑ Deck ❑ Re -Roof
❑ Commercial V Residential ❑ Change of Use
❑ Pool ❑ Re -Side
. EST. VALUATION OF WORK ❑ Finish Basement
❑ Retaining Wall. ❑ Fence
$ $5100.00 ❑ Remodel
❑ Porch ❑ Shed
Square feet: ❑ Addition
❑ Demolition _❑ Window/Door_Replacement_
❑ Garage-Attached/Detach
❑ Plumbing -provide detail on Page 2 # being.replaced
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Detailed Description of Work: ❑ Accessory Structure
d Mechanical -provide detail on Page 2 ❑ Misc Other
Signature of this application by the legal property owner or a licensed contractor, as the owner's representative, is required and authorizes the Zoning Administrator or designee and the Building Official
or designee to enter upon the property to perform needed inspections. Entry may be without prior notice. I hereby acknowledge that I have read this application and state that all information is true and
correct to the best of my knowledge. I further agree that all work performed will be in accordance with
approved plans, specifications and conditions and to abide by all ordinances of the Municipality
and the laws of the State of Minnesota regarding actions taken pursuant to this permit. I agree to pay all plan review fees even if I choose not to proceed with the work. Permit expires when work
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is not commenced within 180 days from date of permit, or if work is 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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will 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: ,(Q/Zlli ,L„ G�
DATE: 11/06/2018
PRINTED NAME: JOANN L ZIN N
This is the signature of: ❑ Owner or Ill Owner's Representative
OCCUP. TYPE: CONST. TYPE: CODE:
BLDG SPRINKLED Yes / No
VALUATION: $
Permit Fee: $
WAC Charge: $
Plan Review Fee: $
Sewer & Water Hook -Up: $ 1
State Surcharge: $
Sewer & Water Disconnect: $
Site Inspection Fee: $
Water Meter: $
S.E.C. Fee: $
Muni SE/WA Fee: $
Investigation Fee / Other Fee: $
*2016 SAC Escrow/ 2 485 IA
J
Copy Charge ($.25 per 8.5 x11 page) $
-
Other: $
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License Check ($5) / Lead Check ($5) $
TOTAL DUE: $
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SUB -TOTAL $
N
Plumbing Fee (from Page 2) $
*NOTE: Commercial plans will be submitted to the Met Council Environme t I Svcs
for SAC determination. Escrow payment will be required when permits' . If
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Mechanical Fee from Page 2) $ D
after Met Council review no SAC is determined, escrow will be refunded in full.
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Special Conditions/Required Setbacks:
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Building Approval By:
DATE:
Printed Building Approval By:
❑ License Verification ❑ Lead Verification - Checked By:
City Approval By:
DATE:
Paid: 3 — Date: 11 j q Receipt No.
Ct W By:
r_.A
CITY OF SPRING PARK MECHANICAL PERMIT
❑ PLUMBING PERMIT
PAGE 2 FOR PERMIT ISSUANCE
PAGE 1 and PAGE 2 should be complete
MECHANICAL •' •
Mechanical Contractor: CENTERPOINT ENERGY Address: 6161 GOLDEN VALLEY RD
City: GOLDEN VALLEY State: MN Zip: 55422 Phone: 763-512-2765 Fax: 763-512-2663
State Bond No: MB003503
lContact Name: JOANN ZINKEN
Email: joann.zinken@centerpointenergy.com
I Contact Phone: 763-512-2765
Detailed Description of Work: INSTALL/ REPLACE FURNACE
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
_ 1 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
Office Use Only: p
Replacement (one fixture only, no piping or vent changes) Mechanical Permit Fee: $ �O
❑ Addition/Remodel Gas Line Permit Fee: $
❑ New Construction State Surcharge: $ / —
❑ Other Other: $
Total Mechanical Permit: $ 10
PLUMBING INFORMATION
Plumbing Contractor: Address:
City: State: Zip: Phone: Fax:
Plumbers License No: IState
Bond No:
Contact Name: I
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 Quanityuani
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 ash Basin Bathtub
Office Use Only:
❑ Replacement (one fixture only, no piping or vent changes)
Plumbing Permit Fee: $
❑ Addition/Remodel
State Surcharge $
❑ New Construction
Other: $
❑ Other
Total Plumbing Permit: $
LICENSE/CERTIFICATE/REGISTRATION DETAIL
MECHANICAL
Class Type: CONTRACTOR Number: MB003503
BOND
Application 120337
No:
Expire Date: 8/20/2020
Orig Date: 9/3/2009
Enforcement NO
Action:
Workplace N/A
Experience:
Status: ISSUED
Effect 8/21 /2018
Date:
Print 8/20/2018
Date:
Name: CENTERPOINT ENERGY RESOURCES CORP DBA CENTERPOINT
ENERGY MINNESOTA GAS
Address: 1240 W RIVER PKWY
MINNEAPOLIS, MN 55454
Phone: 612-321-5597
Business Relationship Requirements
Name: Lic/Reg No:
Status: Application No:
Expire Date: Effect Date:
Orig Date:
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