Permits - Permit# SP19-0005 - 2437 Black Lake Road - 1/1/2019to
CITY OF SPRING PARK PAGE 1
BUILDING PERMIT
4349 Warren Avenue
Spl9 —60)
Spring Park, MN 55384 HandoutGlven
Phone: 952.471-9051 Fax: 952-471-9160 El Lead Handout Given
Routed o M SPECT
ao 1
SITE ADDRESS: 2437 Black Lake Rd PID;
1) Was the home constructed before 1978? (YES o,.conlinue with line 2, NO ff continue without completing EPA Section)
2) Will the work disturb Z6 sq It of Interior painted surfaces or 220 sq ft of exterior painted surfaces? (YES ❑ go to Iine 4, NO ❑ line 3)
3) Are there any windows being replaced? (YES a, go to line 4, NO a continue without completing EPA Section)
4) Has this home been Certified Lead Free? (YES o, you MUST Attach Certification Information, NO o complete line 5)
5) EPA Contractor Certification Number. NAT - (applies to contractor only)
!
PROPERTY OWNER: Scott Kaehler Address: . 2437 Black Lake Rd '
city -.Spring Park state: MN Zip: 55384 Email:
Contact Name: Phone: 612-619-0560
•
CONTRACTOR: Address: 91 A N R@yAr gI1jQA Cl IA -
City: State: MN Zip: 55137 Phone: Fax :: - —z
Contractor License No: BC661813 Contact Name:Wend Rache -Pilo a �:952-314-9885
Email: wrache us atlos stems.com -_-
ARCHITECT: Address:
CI , Slate: Zip, Phone: .7' Fax:
•
Email: Contact Name: ==f% :_-Phone:
TYPE OF WORK:
❑ New Construction ❑ Deck ❑ Re -Roof
❑ Commercial IN Residential
❑ h Change of Use o Poo:�M1 : ;=y o Re -Side
EST. VALUATION OF WORK
o Finish Basement p F3e iining Wall =-=} o Fence
$ 13400
Lk Remodel rdPorc a Shed
Square feet:
L.
❑Addition __ " ❑.RQ7 wlition ;µ` o Window/Door Replacement
a Garage-AttachedfD�t�ch- -k4+plumbing-provide detaa on Page 2 # being replaced
Detailed Description of Work:
❑Accesso . ,:SGii$ture =: _= o Mechanical -provide detal on Page 2 ❑ Misc Other
2 bathrooms - replace 2 vanities,
tops, fateets, replace 2sbower pans, surrounds, valves
Signature of thb epptketion by the NO KOportyowner a a;rcensed mbar. . as tt»;CMIners representallve.Is required and aWwdres the ZeNng Administrator ordeslgnee and the auadkg Official
or deagraee to solar upon the properly to perform needed Inipt tbns. Entry may"
A&A prior notice. I hereby ackrwwtedge that i hero reed two epptketien and male that at information Is true and
correct to the beat of my krontedge. I Ndher agree that a9 w Srti d y.A bt ritcordence iMh approved plans, spectacations end conditm end to abide by at ormwnces of the �Madc46IY
and UA ICA $ of the stets of A&ugsots rey an" actions lakse pUi'a OM td• W§ #wm0. I agree to pay all plan rwAsw revs even If I choose not to proceed with the work. Permit orpkes whin work
brat commenced within 190 days from deSe_df peimC; gir Mpli I sWperded abaMoned. a not Inspected For tip days. Work beyond the scope of Ws permit or wak withal a pent a Inspection.
be "act to a pensly.
Noise OrdinarWh Effect iMOND Y - FRID Y Befor 7 m. and after 10 p.m. WeekendslHolidays before 7 a.m. and after 8 p.m.
SIGNATURE OF APPUICAAT: ( DATE:
PRINTED NAMES W_ Qnd `T�:��Che- T s is the eignature of: ❑ Owneror rXOwner's Re resentative
OCCUP. T1fRET' `--- _ CONST. TYPE: CODE: BLDG SPRINKLED Yes 1 No
VALUATION: %
Permit Fee: $ WAC Charge: $ ��----
Plan Review Fee: $ Sewer & Water Hook -Up: $ / ---
State Surcharge: $ Sewer & Water Disconnect: $ r
Site Inspection Fee: $ Water Meter. $
S.E.C. Fee: $ Muni SEANA Fee:
Investigation Fee / Other Fee: $ '2016 SAC Escror. 52.411
�-
Copy Charge ($.25 per 8.5 x11 page) $ Ot�} $
zLicense
Check ($5)1 Lead Check ($5) $ TOTAL DUE: $ (o 00
SUBTOTAL b
•NOiE: Commercial plans will be sub tied to the Mel Council Environmental eves
Plumbing Fee (from Page 2) $ � -7 (o
W
for SAC determinalion. Escrow payme t wnl be required when permit Is Issued. If
Mechanical Fee from Page 2 $ after Met Coundl review no SAC Is da rmlned, escrow will be refunded In full.
u.
Special Conditions/Required Setbacks:
O
�_--
Building Approval By. DATE:
Printed Building Approval By: ❑ License Verification D Lead Verification - Checked By.
City Approval By: DATE:
Pald: 4 -�&, 6 [,) Date: / a619 Receipt No. of By. J
CITY OF SPRING PARK ❑ MECHANICAL PERMIT
0 PLUMBING PERMIT
PAGE 2 FOR PERMIT ISSUANCE
PAGE t and PAGE 2 should be complete
MECHANICAL INFORMATION
Mechanical Contractor: Address:
City: State: ZI : Phone: Fax:
State Bond No:
lContact 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 e9 typeRfxture):
MECHANICAL FIXTURES OAS LIN(Eq'_- -
s
Quantity QuantityQuantity`:-- -
Fumace Kitchen Fan Furnace
Air Conditioning System Bath Fan Fireplace-3 =
Air Exchanger Grill Unit Heater
Fireplace Water Heat
Unit Heater Grill
In Floor Heat �D►Ytu
Gas Log
QlF7se use Ogly� ;z`_V_r _-
❑ Replacement (one fixture only, no piping or vent changes) _ -_ dlechanicalPermit Fee: $
❑ AdditionlRemodel = _- Gas Line Permit Fee: $
❑ New Construction State Surcharge: $
_ _ 1 Other. $
❑ Other
_-- _:
=- - - g Total Mechanical Permit: $
PLUMBING• i •
Plumbing Contractor: -- — _ Address:
C late: -� - Zi �--- -=� Phone: Fax:
Plumbers License No: Pr-7riiak
State Bond No: 7900440844
Contact Name: - -
Contact Phone: 952-314-9885
Email: wracite Us atio stems com
Detailed Descri tibn of'Wo : 2 bathrooms- replace 2 each- vanities tops, faucets shower pans, surrounds valves
Indicate type of project and fixtures you will be installing or replacing (include count for each type of fixture):
PLUMBING FIXTURES
Quantity Quantity Quantity
Water Heater 2 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.
2 Lavato ash Basin Bathtub
❑ Replacement (one fixture only, no piping or vent changes)
Office Use Only: —7
Plumbing Permit Fee: $
❑ Addition/Remodel
State Surcharge $ / —
❑ New Construction
Other: $
❑ Other
Total Plumbing Permit: $ ? t`a
t t i 5-e r
_0
Please see enclosed checks for payment for permits for the following properties:
2437 Black Lake Road $76.00
2400 Interlachen Rd Unit 317 $82.70
Please send permits to
US Bath -Systems
Attn: Wendy Rache
218 N River Ridge Circle
Burnsville. MN 55337.
Thank you!
THIS CARD MUST BE VISIBLY POSTED, CITY of SPRING PARK
ACCESSIBLE, AND PROTECTED FROM
WEATHER AND PHYSICAL DAMAGE PERMIT CARD
FOR THE DURATION OF THIS PERMIT.
(VALID FOR A SINGLE PROJECT)
Permit #
5P19 - 000s
Site Address: a 39 Black l_&ke g d Building: - fesI d0l Qf-
Owner Name: VCQj± iaeW e r
Contractor Name: OS Patio Svsknis
Contractor License: PC -708aDlQ /i P-61419 / 3 Date issued: aI ► �-Oi `j
REFER TO HANDOUT FOR INSPECTION REQUIREMENTS
OFFICE USE
F-1 ROOFING
SIDING 0 WINDOW 0 DOOR
HANDOUT
INSPECTOR:
DATE:
Issued by:'15 Received by: Na
FENCE p SHED
Front: Back:
INSPECTION:
DATE:
Side: Side:
MECHANICAL
FIREPLACE 4 PLUMBING
COMMENT
ROUGH -IN:
DATE:
Pressure test for plumbing and hvdronic pining
_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. All work must comply with the MN State Building Code.
PHONE (952) 442-7520 MNSPECT, LLC TOLL FREE (888) 446-1801
LICENSE/CERTIFICATE/REGISTRATION DETAIL
PLUMBING
Class Type: CONTRACTOR Number: PC708206
Application 372439
No:
Expire Date: 12/31/2019
Orig Date: 5/10/2016
Enforcement NO
Action:
Workplace N/A
Experience:
Status: ISSUED
Effect 1 /1 /2018
Date:
Print 11/6/2017
Date:
Name: US PATIO SYSTEMS INC DBA US BATH
SYSTEMS INC
Address: 218 RIVER RIDGE CIR N
BURNSVILLE , MN 55337
Phone: 800-581-3517
Business Relationship Requirements
Name: MCDERMOTT,
JEFFREY D
Status: ISSUED
Expire 12/31/2020
Date:
Orig Date: 12/22/2015
Another Lookup?
Lic/Reg No: PM690527
Application 360406
No:
Effect Date: 1 /1 /2019
LICENSE/CERTIFICATE/REGISTRATION DETAIL
RESIDENTIAL
Class Type: BLDG Number: BC661813
CO NTRACTO R
Application 308775
No:
Expire Date: 3/31/2020
Orig Date: 1/25/2013
Enforcement NO
Action:
Workplace N/A
Experience:
Status: ISSUED
Effect 4/1 /2018
Date:
Print 3/26/2018
Date:
Name: US PATIO SYSTEMS INC DBA US BATH
SYSTEMS INC
Address: 218 RIVER RIDGE CIR N
BURNSVILLE , MN 55337
Phone: 800-581-3517
Business Relationship Requirements
Name: MADDEN,
RAYMOND B
Status: ISSUED
Expire 5/8/2020
Date:
Orig Date: 5/8/2014
Another Lookup?
Lic/Reg No: QB680944
Application 334543
No:
Effect Date: 5/9/2018