Permits - Permit# SP14-023 - 2436 Black Lake Road - 1/1/2014MAY 2 1 En
CITY OF SPRING PARK
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4349 Warren Avenue Spring Park, MN 55384
Noise Ordinance In Effect:
Phone (952) 471-9051 Fax (952) 471-9160
Monday -Friday
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before 7 a.m. and after 10 p.m.
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PLUMBING PERMIT
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Weekends/Holidays
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before 7 a.m. and after 8 p.m.
DATE: 5 �U
PM No.
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Pipelayers Card No.
SITE ADDRESS: 'L 3Y ` (Lc�
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OWNER N e,t 1 CV- ,WV1 � e
PLUMBING CONTRACTOR Name / A dress / City / State / Zip / Daytime Telephone
Blvd.
ESTIMATED VALUE
Shakopee, MN 55379
CLASS OF WORK: ( ) New ( ) Addition ( ) Alteration (�) Replace
TYPE OF WORK: Residential ❑ Commercial
Water Closet (Toilet) Bathtub
Roof Leader -Rainwater
Lavatory (Wash Basin) Shower
Drinking Fountain
Kitchen Sink & Disp. Dishwasher
Lawn Sprinkler System
Water Heater Clothes Washer
Water Meter
gLGas ❑ Electric Water Softner
Water Connection
Ice Maker Line Piping/Treating Equipment Sewer Connection
Rough -in Future Fixture Floor Sink or Drain
SAC
Vacuum Breakers Sump
Plumbing Comments:
Fixtures @ $5.00 each': $
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State Surcharge: $
.50
$
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Total PLUMBING Permit: $ 0C
`Minimum Fee of $50.00
Signature of this application by the legal properly owner or a licensed contractor, as the owner's representative is required and authonzes the City Zoning Administrator or designee and the Cily Budding Official or designee to
enter upon the property to perform needed inspections. Entry may be without prior nalice. I hereby acknowledge that I have read this applicalion and slate
that all informalion is True antl cenect to the bell of my knowletlge,
further agree that all work performed will be in accordance with approved plans, specilicalions and conditions and la abide by all ordinances of the City and the laws of the Slate of Minnesota regarding actions taken pursuant
this peril I agree to pay all plan review fees even if I choose not to proceed with the work. Permit expires "ben work is
to
not
abandoned or not inspected for 180 days, Work beyond or without a permit or inspection will be subject to a penally.
commenced with 180 days from dale of peril issued, or if building and work is suspended.
Call MNSPECT for inspectio t (952) 442-7520. (24 Hour Notice) 8:00 a.m. - 4:30 p.m.
SIGNATURE OF APPLICANT: l P
DATE: h 2� I
PRINTED NAME: gWti C
DATE:
For All Rough -In And Final Inspections Call MNSPECT At (952) 442-7520 (24 Hour Notice)
For Sewer/Water Inspections Call City Hall At (952) 471-9051
THIS CARD MUST BE VISIBLY POSTED, CITY & SPRING PARK Permit
ACCESSIBLE, AND PROTECTED FROM'
WEATHER AND PHYSICAL DAMAGE PERMIT CARD KP4-073
FOR THE DURATION OF THIS PERMIT.
(VALID FOR A SINGLE PROJECT)
NATURE of WORK: e r ea. I e w
Site Address: Sf. cue LP Building:
Applicant Name: ' c (bS Date Issued: _1Z • a Z
INSPECTION RECORD
REFER TO HANDOUT FOR INSPECTION REQUIREMENTS OFFICE USE
[Q ROOFING Q SIDING WINDOW [] DOOR , HANDOUT
MUST :CALL TO`SCHEDULE'NO LATER THAN THEL BUSINE55 VA NKIUK, I u: i:nt inla0rct..I:w1vyMT
Permit well expire 180 day r after Issuance. All work must comply. with the MN State Building Code. .
V ` 140NE (952-442-7520 = MNSPECT. LLC .-:`: TOLL FREE (9991.446-1901
FOR CITY USE ONLY
Date Received: (3ermit #
-House SAC Detemunation_Fo;m Completed
Approved By (If kequired):
SPRING PARK
On Lake 31innetonka
4349 Warren Ave
Spring Park, MN 55384
952-471-9051
CITY OF SPRING PARK — SEWER & WATER / GENERAL PERMIT
(* Note: Some permits may require approval by the Building Official and/or Public Works Department •)
(ALL PERMITS - May be subject to further review and may not be issued when the application is received)
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GENERAL INFORMATION
1. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will be sent by return mail
within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the permit card is available on the job site.
5. Utility connection permits may be issued to licensed contractors only.
6. Contact the Public Works Department (952471-9051) for utility stub as -built locations.
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public
Works Department. Issuance of a permit does not grant this approval.
7. All work must be done in accordance with State Code requirements.
8. All work must be inspected before it is covered. Call (952) 471-9051, 24+hour notice required.
TYPE OF PERMIT (Check All That Apply)
(May Require Approval) ❑ Commercial (Approval Required) Industrial (Approval Required)
❑ New Connection ❑ Additional Connection ❑ Re -Connection airs ep ❑ Disconnect
❑ Water Availability Connection for Future Hook -Up to Water
Job Site / Owner Information:
Site Address: d.- � 3 Q ( c v, (C
Owner l� ; + I 5 h o 8 n �) o 40 Mailing Address:
City: J Ap r, nU Pal r Iz Zip:
Home Phone: 1 q%) Alternate Phone:
Contractor Information:
Contractor:
Address:
City:
Phone: 5 P431-1504
Zip:
Contact Person:
State Lcense-
Expiration Date:
Alternate Phone:
SAn^�
5 �1Ez
6es>FFastes
ASAP Underground LLC
2355 Fairview Ave #371
Roseville 55113 LN PC664926
Master Plumber Christopher Milow
LN PI�¢060369
y:\forms\spring park sewer & water permit.docx
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DETERMINING PERMIT FEES
❑ SAC Charge (2016 Rate = $2,485.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Spring Park City Staff can determine if applicable)
(If not prepaid, a sewer connection permit will not be issued)
❑ Sewer Connection / Disconnect / Repair ($50.00/Per Stub) $'
Pipe size inches; material Schd 40 air tested;
❑ Water Connection / Disconnect / Repair ($50.00/Per Stub)
Pipe size inches; material air tested; copper
❑ Water Availability For Future Hook -Up to Water ($50.00) $
Water Availability Explanation:
Contractor installed line to inside of house for future hook-up.
This line will be inspected by the Public Works Department.
Required Before Water Connection Permit is Issued:
1. Issue Water Meter & Horn Permit
2. Any Additional Connection Fees Paid (If Applicable)
Issue Water Connection Permit:
1. Collect Permit Fee & Issue Water Connection Permit
1. SUBTOTAL of Permit Requested:
2. STATE SURCHARGE
1.00
3. POSTAGE & HANDLING (Only on Mail -In Applications) $ 2.00
4. TOTAL PERMIT FEE (Add Lines 1-3 Above)
ADDITIONAL INFORMATION — WATER METERS
■ WATER METERS must be picked up and paid for at Spring Park City Hall, these are on a separate permit.
■ WATER METERS must be set and sealed by Spring Park Water Department (952) 471-9051, upon completion of meter
installation.
The undersigned hereby applies to the City of Spring Park for issuance of a Utility Permit, agrees to do all work in strict
accordance with the ordinances of the CitX,and the regulations of the State of Minnesota, and certifies that all statements
made on this appligat on. e?,try. ejnc�/.'77:s
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ApplicraritY, Date:
Revised: 4/21/2016 ''"° :1►-" i ;'.I
SEWER & WATER PERMIT
2
y:\forms\spring park sewer & water permit.docx