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Permits - Permit# 11-03P - 2447 Black Lake Road - 1/1/2011Ftom:CITY OF SPRING PARK 952 471 9160 03/31/2011 11:14 #439 P.002/003 m � C � CITY OF SPRING PARK C Noise Ordinance In Effect r- $ 4349 Warren Avenue Spring Park, MN 55384 z + W Phone (952) 471-9051 Fax (952) 471-9160 Monday - Friday G Q Q before 7 a.m. and after 10 p.m. W - W -0 PLUMBING PERMIT a � X Weekends/Holidays 3 $ before 7 a.m. and after 8 p.m. DATE: PM No. Pipelayers Card No. SITE ADDRESS: ze'd OWNER /i h ne'{ai1 ,,7 PI_LIMB!NG CCOONNTR/A�C�TO, R / Name I Address / City / State / Zip / Daytime Telephone ESTIMATED VALUE CLASS OF WORK: (New ( ) Addition ( ) Alteration ( ) Replace OF WORK: O Residential Water Closet (Toilet) Lavatory (Wash Basin) Kitchen Sink & Disp. Water Heater *Gas ❑ Electric Ice Maker Line Rough -in Future Fixture Vacuum Breakers Plumbing Comments: ❑ Commercial / Bathtub Shower Dishwasher Clothes Washer Water Softner Piping/Treating Equipment Floor Sink or Drain Roof Leader -Rainwater Drinking Fountain Lawn Sprinkler System Water Meter Water Connection Sewer Connection SAC Sump / Q Q Fixtures @ $5.00 each': $ State Surcharge: $ ec For All Rough -In And Final Inspections Call MNSPECT At (952) 442-7520 (24 Hour Notice) For SewerlWater Inspections Call City Hall At (952) 471-9051 Poor Quality Document Disclaimer The original or copy of a document or page of a document presented at the time of digital scanning contained within this digital file may be of substandard quality for viewing, printing or faxing needs. FYom:CITY OF SPRING PARK 952 471 9160 03/31/2011 11:15 #439 P.003/003 CITY OF SPRING PARK Noise Ordinance In Effect: m 3 r- m 4349 Warren Avenue Spring Park, MN 55384 r g t v n Phone 952 471-9051 Fax 952 471-9160 ( ) ( ) Monday -Friday Q Q S � D before 7 a.m. and after 10 p.m. 3 `f V m � z n MECHANICAL PERMIT 3 � Weekends/Holidays before 7 a.m. and after 8 p.m. � 7 Date: J —3l — State Bond No. Gas Fitters License No. SITE ADDRESS: a ,�oY -7 OWNER W,-( ; vtLe � MECHANICAL CONTRACTORRy� Name ! Address / City / State / Zip ! Daytime Telephone ESTIMATED VALUE !2i G'OD r TYPE OF WORK: X,Residential ❑ Commercial New Replacement Other WARM AIR AIR CONDITIONING SYSTEM UNDERGROUND DUCT SYSTEM: Yes ( ) No ( ) / ,f 3 Gravity Forced q�' Tons a CFM Ductwork Input B.T.U. ��� 000 Output B.T.U. VENTILATION ! AIR EXCHANGE Exhaust Only Air Exchange Unit No. of Fans Size Type Type -Mixing Box Heat Recovery Ventilation C.F.M. Del Static Pressure Recovery Efficiency Net Air Flows Where ventilation is usedHocated WET HEAT GAS FITTINGS Baseboard In -Floor Steam Hot Water ❑ Water Heater o Furnace ❑ Stove ❑ Dryer ❑ Grill Gross Sq. Ft. Input B.T.U. o Unit Heater ❑ Fireplace ❑ FIREPLACE No. of Fireplaces Mechanical Permit Fee: $ Fuel Type Gas Fitting Permit Fee: $ Yo. Mechanical Comments: State Surcharge: $ S o 0 Total MECHANICAL Permit: $ Signature of this application by the legal property owner Ora licensed contractor, se the owners representative is required and authorizes tho City Zoning Administrator or designee and the City Building Official or design erty enter upon the propto 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 knowle further agree that as work performed wilt be in accordance with approved plans, specifications and conditions and to abide by all ordinances of the City and the laws of the Slate of Minnesota regarding actions taken pur 10 this permit. 1 agree to pay all plan review fees even If I choose not to proceed with the work. permit expires when work is not commenced with 180 days from dale of permit issued, or if budding and work is suspended. abandoned or not inspected for 180 days. Work beyond or without a permit or inspection will be subject to a penalty. Call MNSPECT forinspectionsat (952) 442-7520. (24 Hour Notice) 8:00 a.m. - 4:30 p.m. �� SIGNATURE OF APPLICANT: / /aDATE: `3S//— PRINTED NAME: Sc /x DATE: For All Rough -In And Final Inspections Call MNSPECT At (952) 442-7520 (24 Hour Notice) Gas Line Air Tests Required M to 18.1 uant T MINNE9OTA DEPARTMENT OF LABOR & INDUSTRY Plumbing Bond 8r Insurance Certificate Construction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road N St. Paul, MN 66166 Webalte: wm%dll.mn.00v E-mail: OLLLicense(Ostateann.us Telephonc , 661.284-6034 This Is to certify that the certificate holder Is in compliance with Minnesota Statutes § 3266.46, Subd. 2 for calendar year 2011 and may engage in the plumbing trade In all areas of the state of Minnesota. SOUTH MECHANICAL CONTRACTORS INC 21005 LANGFORD AVE RONALD J SCHLINK (59502PM) JORDAN, MN 65352 2011 Bond ID: 55163780 Liability Insurance ID: 60064442 UNITED FIRE AND CASUALTY COMPANY UNITED FIRE AND CASUALTY COMPANY MINNESOTA DEPT. OF LABOR AND INDUSTRY CONSTRUCTION CODES AND LICENSING 443 LAFAYETTE RD. ST. PAUL, MN 55155 THIS LICENSE MUST BE IN YOUR PO DURING WORKING HOURS. PLEASE NOTIFY CONSTRUCTION C LICENSING OF ANY ADDRESS CHAN PLEASE CHECK YOUR CARDS FOR ACCURACY. IF YOU FIND AN ERROR, PLEASE CALL 651.284.5031 IMMEDIATELY. WALLET DISPLAY CARD STATE OF MINNESOTA MASTER PLUMBER License # 059502-PM Expiration Date 12/31/2012 5 Original Issued Date 03/29/1990 RONALD J SCHLINK 21005 LANGFORD AVE JORDAN, MN 55352 c fn OE MINNESOTA DEPARTMENT OF OR & INDUSTRY OR Bond Certificate Construction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road N St Paul, MN 55166 Webslte:i www.dll.mn.nov E-mail: DLI.LIcenso0state.mmus. Telephone:,651-284.6896 This Is to certify that the certificate holder is in compliance with Minnesota Statutes § 326121.197 for the period 08/21/2010 through 08/21/2011 and may engage in mechanical contracting in all areas of the state of Minnesota. SOUTH MECHANICAL CONTRACTORS INC Certificate ID: 3107-MB 21005 LANGFROD AVE . JORDAN, MN 55352 Bond ID: 55186415 Effective Date: 8/21/2010 UNITED FIRE & CASUALTY INS CO Expiration Date: 08/21/2011 A� " CERTIFICATE OF LIABILITY INSURANCE 03/31/20111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Jordan Agency, Inc. 111 S Broadway St Jordan MN 55352 CONTACT NAME: P"o"N 952-492-6050 F Ne : 952 492 6051 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A: United Fire & Casualty 13021 INSURED SOUTH MECHANICAL CONTRACTORS I N C 21005 LANGFORD AVE JORDAN MN 55352-9356 INSURER B: INSURER C : INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUB" POLICY NUMBER MPM ICY EFF MP POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY AGE TO PREMISES EaENTED ooarrence $ MED EXP (Any one person) $ 5,000 A CLAIMS -MADE X OCCUR N N 60064442 08/01/2010 08/01/2011 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 Fire Damage $ 100,000 POLICY PRO- JECTLOC AUTOMOBILE LIABILITY COMBINED INGLE LIMIT Ea accident 500,000 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ A ALL OWNED X SCHEDULEDAUTOS AUTOS HIRED AUTOS X NAON-O ED Ix N N 60064442 08/01/2010 08/01/2011 ROP(PerPEERT DAMAGE $ $ A UMBRELLA UAB EXCESSLIAB OCCUR CLAIMS -MADE N N 60064442 08/01/2010 08/01/2011 EACH OCCURRENCE $ AGGREGATE $ DED I X I RETENTION$ 10,000 Commercial Umbrella $ 1,000,000 WORKERS COMPENSATION WC STATLL OTH- AN AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) / A N 60064442 08/01/2010 08/01/2011 E.L EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 E.L. DISEASE - POLICY LIMIT 1 $ 500,000 H yes, tlescribe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addi Tonal Remarks Schedule, it more space is required) CFI7TI1:ICATF NAI r1FR CANCELLATION CITY OF SPRING PARK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4349 Warren Ave ACCORDANCE WITH THE POLICY PROVISIONS. SPRING PARK MN 55384 AUTHOR® REPRESENTATIVE %d� U ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Permit #: 11 -03P/1 1-05M City of Spring Park 4349 Warren Avenue, Spring Park, MN 55384 Plumbing and Mechanical Permits PINS: 19-117-23-12-0027 ADDRESS: 2447 Black Lake Road Permission is hereby granted to: South Mechanical Contractors To install or construct the improvements applied for. This permit is granted upon the condition that the person to whom it is granted, and his agents, employees and workmen, shall conform in all respects to the Ordinances of the City of Spring Park and to the Statutes of the State of Minnesota in such cases made and provided; this permit may be revoked at any time upon violation of any of the provisions of said Ordinances, Statutes, or for any misrepresentation in the application. Approved by MNSPECT, CBO Date: April, 2011 NOTE: This card must be placed in a conspicuous place at the address which work is to be performed. CITY OF SPRING PARK 4349 Warren Avenue, Spring Park, MN 55384 INSPECTION RECORD PINS 19-117-23-12-0027 Building Inspections — Permit No. 11-03B Footings Date Inspector Framing Insulation Wallboard B-4 taping Final Others ADDRESS: 2447 Black Lake Rd Mechanical — Permit 11-05M Plumbing Inspections — Permit # 11-03P Date Inspector Rough -in Air Test Final Permit # Date Inspector Sewer Water Electric Note: Contractor is responsible to call for these inspections. This card must be placed in a conspicuous place, on the premises on which work is to be performed. 952-442-7520.