Permits - Permit# 01-13M - 2436 Black Lake Road - 1/1/2001_ _-, _ _ _ l _ r _ rllj F'1=i^`.4•' b� ic. i�: F; :_''_ _ L1 _ _ • C%
C11Y OF SPRING PARK
P.O. BOX 492
SPRrgG PARK, M1NNlESOTA 55364
612-471-W-1
4PPLICATION FOR MECHANICAL PERMIT
1. 'YOU may appiW for mecbau'"J permits by mailer in peesoa at the City oiflces. !applications will be
reviewed and a permit will be issued w1tblD 2 worms days.
2. Permit. cards will be sent by return maH rafter a review is cempleted. PERMITS ARE NOT VALID
UNTIL YOU RECEIVE h PERMIT. ROU MUSIXOT OW80 TINML THE PE MIX CARD RD 16
PO4TED am 139. JOB SM.
3_ Machanigail Degmu - Complete calculatiant, details and specifications are required for each
beating, ventiktiOR, hulaW.11caffen-debumidiecatfon, sad air condiftniup 19stallation including beat
loes/beat gain calcaladon, desiga temperatures, sgsdpm ent i s and Identification as to t)Ve,
manufacturer and model. Data sball be preacated on roros provided. Ideiatidcadon of and
specifications for water !seating equipment shall also be.provided.
4. When.,, any new constractiva or, remadeling is Involved, a separate building permit most be obtained.
S. AN work must be done in accoirdtfaee with the Uniform Mechanical Code/State Building Code
requirensFssts.
6. All work mast be inspected (rougb-is and taus!). Call 24. 9 4W. A 24 bout notice is required.
7. House Heating Test Record must be submitted before final.
L(�Ta�i37f1rIQhCs Co,upleta all stems ou thib application. Compute the permit fee. Sign and date the
certirsca4on. INCOMPLETE APPLICATIONS WILL NOT BE PROCZSSBD. If you have questions.
call :494W or 471.9051.
Please check one: New _ Addition — RePair _...._ Replace
ResldeotiAl__�( �, Commercial ter,
JOB SITIE_• oZ�Qo(o 1GlG� I-G-V'l2� R(A
Owner's Name �, i r1 �� Me- \ �n Z hc� �e�l Phone Number s a - 11-
Mailing Address 38ufYl2_,._
Contractor's tame _ (�C r I Phone Number
Mailing Address l v .
KLAT94G SYSTFMC
Quantity
Model
Fuel K)Ci
Flue Size ` it
Input BTU$ `i s , o oa _
output BTU5 _eb, ono
CiaM
COOKING 51.'STEhiS 1
Quantity
Maine R�
Model
ToasH. Power
0
-meabauimi Perms
,WOOD t31.'L-NVG EQUWNW5T
Wood s.vve with Ox* _ . --
Wood cumbivatton or add -on ---
Factory fireplace aalth flux Freestanding Masonry
Factory fireplace(s)_
Wood Stove (s) Franklin, outer name-- _ � Modol �v
Brand name
Mfgr's % ., Clearaucea, Side rear Total
Aug dla
tn
Total
VTMILATION
No. __._ kitchen exha�t - ducted ,_. recirculating _,,,,.� efoa
No. ^ Batt, exhaust (mugbe ducted out")efm
No. Other fans. Lacatlans eiaan —
Total
n-EL STOAAGE (MUST BE APPRON XID BY FIRE MARSHALL)
Instaalation Removal
Fuel Oil gallons underground __.r--1091de outside
LP Gas _J gallons gas opening
Other
Piano rE E GALCLL&riQ
1, 1,25% of t;o gudzda * orb .� 1m(��
► 0,_I - x A1�5 Zi U
(Contract Price)
2. state Urcham "" Add the State Build Code Division � pU
Surcharge to each permit. mil-` W — U _ •�� --
,. -... -
(Contract Price)
or $.50, whichever is treater
3. PitxhdlHlt (Ontp matfl-lo applicatioua) $ SQ —
4. TOTAL: PRR- rr nt (Add hoes 1-3 above) - -
+ CO?N-TR,ACT PRICE or JOB COST Mono the actual or estimated dollar amount charged far the
permitted work includlag materials, labor, preflt, and other And eostg. It is the amount to be charged
to the customer for the wort done- If any material, equipment, labor, or Installation are furnished by
the owner, tenant, or any other psAY, the reasonable a wket value of such items man be added to the
estimated cost or contract price for permit fee purposes, In the event 0" is 2 dispute con�tlhe amount
of the job cost, the City vary request the submission of & signed copy f the
The STATE SEIRCHARCF is .0005 of the cantrauct price under S1,000,000 or S.50, whichever Is
greater. For valuations over $1,0004000 call the Department of IreWational Services far the
price.
The undersigned hereby applies to the City for iSmance of a Mscb uicoel Permit, agrees eo do all work
in strict accordance with the ordinances of the City and the regtda 00 of the Mlanesota Sate Building
Code, and certillks thatA statements and this application are complete, true and corrreect.
Applicant's Signature Date
Approved By _ _._Date - -- —