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Permits - Permit# 94-18 - 2433 Black Lake Road - 1/1/1994CITY OF SPRING PART: APPLICATI OX FOR MECHANICAL PMW'r • COMMERCIAL GmamAL INPOP14ATION 1. You may appl;_y for mechanical permits by :nail (P.O. Box 452, SPRING PARK MN 5533f.), or in person at the City offices ( 4349 WARREN AVE.' ?. Submit' plans for review with this application. Plan review will require A minimum of seven days for staff review. 2. PERMITS ARE NOT VALII� TIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL M PERMIT CARD i 'LrPO TED ON TEE JOB SITE. 3. when +yany new construction <or remodeling.is involved, a separate building permit must be obtained. 4. All work must be done in accordance: with State Building Code requir,ments. S . Al l work must be inspected (rough -in and f in' i.). Call 473-7357. 24-hour notice required. 6. Beating Test Record must be submitted before final mechanical inspection. INSTRUCTIONS Complete all items on this application. Compute the permi" fee. Sign and.date the credential certification. INCOMPLETE APPLICATIONS SILL NOT BE PROCESSED. If you have questions, call 473-7357. You will be notified by phone when the permit review,is.complete. Permit will be issued to contractors at the City offices �!*71r##7tllt�tatliKlr*#tR*#f#*f*#ft*t�rttR�t!*fttf*t!!#!t#�rfffi�**dr!!*fir#tlfff�*f!'!!llrti Please check one: _LNew Addition Remodel, Replace JOS sxTE A433 UdMaAJ 903d tZL ' lam. owner Is Nam` Teieohone Number Mailing Address Rd atb j Mk) mdu _1, Telephone Number Mailing Address aW, s!t*yM!#**!tM*�ItTr�e�Mle*yk#ltit*tt�tlale!!t►*#�!!*ffftftf*!#!*�tl�#f'i!!tf*f�rtf**f*fflf*t*lrilAi MINIMUM FEE 'a�30.00 per project) lfltf*fifflf�t�!!!i!#*R###*#!!!*�tfflflii*fl�lttld�ftf!!lt�l�ltltlf*#'*flfl4lryr*14!!!d VMaM�rxrx SYSTEMS $15.00,' per 50. 400 BTU : output; STING SYSTI !-S $1�OO er 50400 BTU output ii08L nat. gas, 1p gas '.r..� oil# elect. other (spec�.fy if cam 1nation burner) �E IIxP. other more t an unit per Bldg• list each separately) ON '— TYPE BTUH XMPUT BRAND NAME MODEL N0. .a. furnace �- hw boiler unit heater solar htg. I equipment Total Solar Equipment $50.00 eacW system AIR CONDITIONING $15.00 per ton air .Central Air Separate Central Air System w/furnace Brand name Model No. Tons Tots REPRIGIMMION $15.00 per compressor Total Number of Compressors Total — **�***�r***�**+�*�,r*******,t**�* ��� ***�***x*�►w**err*�*err****�********�*�***-A VENTILATION 15.00 ach project cfm No. 'Kitchen Exhaust ted recirculating cfm No. Bath Exhaust (must �e ducted outside)1/(°u cfm No. Other Fans: Locations Total FUEL STORAGE (must be approved by fire marshal) $30.00 Permanent/Temporary Fuel oil, gallons __ underground inside �� outside LP Gas, gallons Other GAS LINE IINSPSTION High/Low Pressure �S.P $15.00 PERMIT FM CALCULATION 1. Total of above installations or Minimum Fee ($30.00) $ 2. State Surcharge,. Add the State julldinq Code Division $ ■50 3urc arge to each permit 3. Plan Review. Fee (65% permit fee) 4. TOTAL PERMIT FEE add lines 1-3 above: The undersigned' hereby applies to the City ,of issuance' of a Mechanics Permit, agrees to do all work in strict accordance with the ordinances o the City and the regulations of the Minnesota State Building Coded an certifies that all statements made on this application are complete,tru and correct. �'1 , /—) Appli Date FORM B SUPPLEMENTAL DATA FOR BUILDING PERMIT Loc-pion of Work 4L(v /* A. - GENERAL INFORMATION Application Number Tax Parcel Number r1. Applicants' Name (Last, First, M.I.) I 2. Day Phone 3. Evening Phone y' /i/� 71 _ 7 4. General Contractor 5. Electrical Contractor 6. Plumbing Contractor ��f4w;A� Z-412-Ae' 1-4�'soc Z/& 7. Earthwork Contractor 8. Architect 1. Type of Project a. New Construction b. Addition c. [) Relocation d. [ ] Repair e. [ ] Foundation Only f. (J Roofing g. [) Other (specify) 2. Proposed Use a. Single Family b. ] Multiple Family c. (] Agricultural d. (] Public e. [ ] Commercial f. (] Industrial g. [ ] Other:(specify) 3. Lot Dimensional Data a. Area In f .2 or acres: b. Lot width at building line: c. Lot depth: d. Lake/Stream setback: e. Road setback: I. Side lot setback: g. Minimum access elevation: R Pan.IFCT INFORMATION Proposed Required i _ Me, wo - 4. Water Level Data • Calculation of Regulatory Flood In: (] Sea Level Datum Protection Elevation (RFPE1 ' [ ] Assumed Datum d Base Flood (100-yr ) a. Highest known Elevation: _ e. Freeboard /req'd water level : = b. Highest known ground by ordinance: _ water level: = f. Ffoodway Stage c. Ordinary high Increase: _ water level: = g. RFPE : _ (add d.,e. and f.) 5. Structure Type 6Q Residence ( ] Ag. Bldg. [ ] Garage (] Storage [ ] Office [ ] Boathouse [] Warehouse [] Deck (j Other (specify below) C STRUCTURE DATA 6. Sewage Disposal 7. Water Supply �j Public Public [ ] Drainfield (] Private Well [ j Holding Tank [ ] Alt. System 1. Structure Elevation Requirements 2. Structure Dimensions 3. Type of Construction 5• Project Cost Factors In: [ ] N.G.V.D. _ x Length ft a. Len ( ) ' Wood/Frame a. Cost of Improvements: b. Estimated Value of (J Assumed Datum (]Masonry UGa Existing Structure: s oetal [ ] In relation to street b (ft.) pole c. Percentage Cost of proposed required 2 Areas In ft-- Bldg. [ ] On -site Prefab Improvements: t) '6 (a. divided by b. X 100 percent) a. Basement or ��,,7� [ j Off -site Prefab (lowest Floor): = b. First Floor c. Basement rt Z�7 14. Heating 6. Summary of Supporting Documents (above grade): = d. 1 Floor = �P7 nd e.2 Floor =_ [ ] Oil [ ] Sketch Plan (FORM H) [ ] Lot Profile c. Max. Buildin g KGas Li Plan Lighting (] Elevation View (] 9 9 Height: = I. Total Area =1:6,0_ (] Electric (] Plan View [ ] Plumbing d. Fill Elev. Adjacent [ ] Wood [ ] Topo Survey [ ] Lot Survey to Structure: _ [ j Solar [ J Other (specify below): I hereby certify with my signature that all data on my application forms, plans and specifications are true and correct to the best of my knowledge: Date Signs a plc 2fnt BUILDING PERMIT (] APPLICATION IS HEREBY DENIED 1 [ ] PERMISSION IS HEREBY GRANTED TO all In accordance with the application, addendum form, plans, specifications and all other supporting date, unless specified hereinafter In the GENERAL and/or SPECIAL PROVISIONS. 0 ZY ORDER OF: Signature of Permitting Authority Title Date NOTE: THIS PERMIT TERMINATES ON: except as provided for by local ordinance and/or Minnesota law. SEE REVERSE FOR GENERAL AND SPECIAL PROVISIONS - M O N R-MAY,1987 PAGE 2 FORM B - BUILDING PERMIT GENERAL PROVISIONS This permit (J is ; ( ]is not subject to the State Building Code. 2. No changes in plans or specifications can be made to the work authorized herein unless such change is first approved in writing by the permitting authority. Permittee shall Grant access to the site at ail reasonable times so that the permitting authority or his/her agents may conduct inspections to ascertain compliance with the terms and conditions of this permit. The construction site shall be kept reasonably free of debris at all times so as to not create a public nuisance. 5. Permittee shall instail permanent and temporary erosion control measures in order to prevent erosion of disturbed soils from the project site onto adjacent parcels of land, public waters, public roads, ditches, sewer facilities and the like. Permittea shall cease all related authorized construction activities until such time as any such problem is corrected as agreed to by the permitting authority. 6. No certificate of occupancy or zoning compliance may be issued until all the provisions and conditions of this permit are complied with in full. A copy of this permit or an offic'al notice or placard thereof must be posted in a conspicuous place protected from the effects of weather no more than 12 feet above grade on the premises which the work is to be done and shall be maintained there until completion of said work. The granting of this permit does not exempt the permittee from having to secure other permits from other state, federal or local units of government which may have jurisdiction over portions of the authorized project. SPECIAL PROVISIONS 1. 2. 3. I 4 Ii I i • 6. i I a. _ - © W.S. BOOTH, BAKER BLDG.. MPLS. 55402 SECURITY BLANK BOOK, 366 WACOUTA, ST. PAUL 65101 294 Permit $45.00 ��� 94-18 Pln Rev 29.25 �._..�.._.. -st-itr--'.!)U' Total $74.75 City of Spring Park btate of A1111 dat County of Hennepin office of Building Inspector Mechanical permit IN CONSIDERATION OF The statements made by West Air is his __application therefor duly filed in this office, which application is hereby made a part hereof, PERMIS IpN �S HEREBY 5RMTED To said— West Air _ _ as owner ^-InA R urnace ,00 BTUH, 3 bath exhausts upon that tract_of-landAescribed_as follows: Lot___ —_loch- _ ; plat or addition__ . 112433 Black Lake Road' (Andrew Frieler) 19-117-23-12-0019 L auaY wu which tract is of the size and area specified in saia application. This permit is granted upon the express conditions that said owner and h. ! s . contractors, agents, workers and employees, shall comply ' 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__Clerk _ this__4th day of August 19 94 Attest: Clerk Building Inspector