Permits - Permit# SP18-46 - 2433 Black Lake Road - 1/1/2018CITY OF SPRING PARK
PAGE 1 BUILDING PERMIT
4349 Warren Avenue
Spring Park, MN 55384
Handout Given
Phone: 952-471-9051 Fax: 952-471-9160
❑ Lead Handout Given
3 bi /.� � L-fJ SITE ADDRESS:di 3O
9/PID: � I " � ! r?
1) Was the home constructed before 1978? (YES ❑, continue with line 2, NO ❑ 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 o line 3)
3) Are there any windows being replaced? (YES ❑, go to line 4, NO o
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- br `,✓ G r
Address kt
n
Ci te: t' 1 Zi :
Email:
Contact Namea ila — nn
Phone: _ 03
•
CONTRACTOR: 12850 Chest
Address:
City: Shakopee: Mid M79
Phone: Fax:
Contractor License No
Contact Name: Phone:
Email: I L h0d_
ARCHITECT:
Address:
Cit : State: Zip:
Phone: Fax:
•
Email:
Contact Name: Phone:
TYPE OF WORK: ❑ New Construction
❑ Deck ❑ Re -Roof
❑ Commercial Residential ❑ Change of Use
❑ Pool ❑ Re -Side
EST. V U WORK ❑ Finish Basement
❑ Retaining Wall o Fence
$ UOF (� ❑ Remodel
TI
❑ Porch ❑ Shed
Square feet: ❑ Addition
❑ Demolition ❑ Window/Door Replacement
❑ Garage-Attached/Detach xPlumbing-provide detail on Page 2 # being replaced
Detailed Description of Work: ❑ Accessory Structure
❑ Mechanical -provide detail on Page 2 ❑ Misc Other
•
Signature of this application by the legal property owner or a licensed contractor, as the owners 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 I work is suspended, abandoned, or not
inspected for 180 days. Work beyond the scope of this permit, or work without a permit or inspection,
•
ill be subject to a penalty.
Noise Ordinance In Effec NDAY-fRIDAY Before 7 a.m: a
after 10 p.m. Weekends/Holidays before 7 a.m. and after 8 p.m.
SIGNATURE OF APPLICANT:
DATE:
PRINTED NAME: IM ilp 164
This is the signature of: ❑ Owner orX Owner's Representative
OCCUP. TYPE: CONST. TYPE: CODE:
BLDG SPRINKLED Yes / No
VALUATION: $
Permit Fee: $
WAC Charge: $
Plan Review Fee: $
Sewer & Water Hook -Up: $
State Surcharge: $
Sewer & Water Disconnect:Pwill
Site Inspection Fee: $
Water Meter:
S.E.C. Fee: $
Investigation Fee / Other Fee: $
Muni SE/WA Fee:
*2016 SAC Escrow:
}
Copy Charge ($.25 per 8.5 x11 page) $
Other:
ZLicense
Check ($5) / Lead Check ($5) $
TOTAL DUE:
SUB -TOTAL $
y
^
a I
`NOTE: Commercial plans will be submitted tnvironmental s
D
Plumbing Fee (from Page 2) $
for SAC determination. Escrow payment willermit is issue f
W
U
Mechanical Fee from Page 2 $
after Met Council review no SAC is determirefunded in full.
LL
Special Conditions/Required Setbacks:
LL
O
E
Building Approval By:
DATE:
Printed Building Approval By:
❑ License Verification ❑ Lead Verification - Checked By:
City Approval By:
DATE:
Paid: (. Date:
Receipt No.
a, By:
CITY OF SPRING PARK ❑ MECHANICAL PERMIT
❑ PLUMBING PERMIT
PAGE 2 FOR PERMIT ISSUANCE
PAGE 1 and PAGE 2 should be complete
MECHANICAL INFORMATION
Mechanical Contractor: Address:
City: State: Zip: Phone: Fax:
State Bond No:
JContact Name:
Email:
lContact 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
Office Use Only.
❑ Replacement (one fixture only, no piping or vent changes) Mechanical Permit Fee: $
❑ Addition/Remodel Gas Line Permit Fee: $
❑ New Construction State Surcharge: $
❑ Other Other: $
Total Mechanical Permit: $
PLUMBING INFORMATION
Plumbing Contractor: Address:
u,.
Cit : State: n Phone: Fax:
Plumbers License N 0 i coil iut 11JIVU.
State Bond No. VC -
", . 154
Contact Name: n62 145a804-
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
uanity- Quanity Quanity
I 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 Only.
Replacement (one fixture only, no piping or vent changes)
Plumbing Permit Fee: $
❑ Addition/Remodel
State Surcharge $
❑ New Construction
Other: $
❑ Other
Total Plumbing Permit: $ a0 `�
LICENSE/CERTIFICATE/REGISTRATION DETAIL
MASTER
Class Type: PLUMBER Number: PM057209
Application
119648
Status:
ISSUED
No:
Effect
Expire Date:
12/31 /2018
1 /1 /2017
Date:
Print
Orig Date:
10/5/2009
10/31/2016
Date:
Enforcement
CE
[View
NO
Action:
Status*:
details]
Workplace
N/A
Experience:
CE status must be MET before this license
can be renewed.
Name: RIPPEL, JAMIE J
Address: 3035 MARCIA LN
SHAKOPEE , MN 55379
Phone: 952-445-4803
Another Lookup?
THIS CARD MUST BE VISIBLY POSTED, CITY of SPRING PARK Permit
ACCESSIBLE, AND PROTECTED FROM
WEATHER AND PHYSICAL DAMAGE PERMIT CARD SP18-046
FOR THE DURATION OF THIS PERMIT.
(VALID FOR A SINGLE PROJECT)
Site Address: a�33 1 ate— W k Building: resi(, zll
Owner Name: pfy& ler
Contractor Name: A-DDI i CC, Ct3n n e-Cfi M5
Contractor License: R M bS % btb 1 Date Issued: I I lei I a-0 I?"
REFER TO HANDOUT FOR INSPECTION. REQUIREMENTS
OFFICE USE
0 ROOFING
0 SIDING ED
WINDOW Q DOOR
HANDOUT
INSPECTOR:
DATE:
Issued by:' -f-75 Received by: ryA
0 FENCE 0
SHED
Front: Back:
INSPECTION:
DATE:
Side: Side:
MECHANICAL
❑ FIREPLACE
0 PLUMBING
COMMENT
_ROUGH -IN:
DATE:
Pressure test for plumbing and hydronic piping
_GAS LINE:
DATE:
Air test required 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. Ali work must comply with the MN State Building Code.
PHONE (952) 442-7520 MNSPECT, LLC TOLL FREE (888) 446-1801