Permits - Permit# SP17-032 - 2494 Black Lake Road - 1/1/2017CITY OF SPRING PARK
PAGE 1 BUILDING PERMIT
4349 Warren Avenue
Handout Given 1 9- ,0 3a
Spring Park, MN 55384
Phone: 952-471-9051 Fax: 952-471-9160
0 Lead Handout Given
SITE ADDRESS: 2494 Black Lake Rd
PID: 19-117-23-12-0023
1) Was the home constructed before 1978? (YES ❑, continue with line 2, NO q(continue without completing EPA Section)
2) Will the work disturb a6 sq ft of interior painted surfaces or a20 sq
ft of exterior painted surfaces? (YES ❑ go to line 4, NO ❑ line 3)
3) Are there any windows being replaced? (YES ❑, go to line 4, NO ❑
continue without completing EPA Section)
4) Has this home been Certified Lead Free? (YES ❑, you MUST Attach Certification Information, NO ❑ complete line 5)
5) EPA Contractor Certification Number. NAT -
(applies to contractor only)
PROPERTY OWNER: Paul Engle
Address: 2494 Black Lake Rd
'
city: Spring Park state: MN zip: 55384
Email:
Contact Name:
Phone:
•
CONTRACTOR: Twin City Fireplace 8, Stone Co.
Address: 6521 Cecilia Circle
city: Edina State: WN zip: 55439
Phone: 952.777.4125 Fax 952.942.2093
Contractor License No: B682 77
Contact Name: Beth Ayers Phone: 952.777.4125
Email: beth@twincityfireplace.com
ARCHITECT:
Address:
City: State: Zi :
Phone: Fax:
•
Email:
Contact Name: Phone:
TYPE OF WORK: ❑ New Construction
❑ Deck ❑ Re -Roof
❑ Commercial q(Residential ❑ Change of Use
❑ Pool ❑ Re -Side
EST. VALUATION OF WORK ❑ Finish Basement
❑ Retaining Wall ❑ Fence
$ 7,365.00 ❑ Remodel
❑ Porch ❑ Shed
Square feet: ❑ Addition
❑ Demolition ❑ Window/Door Replacement
❑ Garage-Attached/Detach
❑ Plumbing -provide detail on Page 2 # being replaced
�
Detailed Description of Work: I ❑ Accessory Structure
echanical-provide detail on Page 2 igMisc Other
Install two gas fireplaces
Ignature of this application by the legal property owner or a licensed contractor, as the owner's representative, is required and authorizes the Zoning Administrator or designee and the Building Officiai
or designee to enter upon the property to perform needed inspections. Entry may be without prior notice. I hereby acknowledge that I have read this application and state that all information Is we and
correct to the best of my knowledge. I further agree that all work performed will be in accordance with approved plans, specifications and conditions and to abide by all ordinances of the Municipality
and the laws of the State of Minnesota regarding actions taken pursuant to this permit. 1 agree to pay all plan review fees even N I choose not to proceed with the work. Permit expires when work
.o
is not commenced within 180 days from date of permit, or if work is suspended, abandoned, or not
inspected for ISO days. Work beyond the scope of this peard, or work without a permit or inspection,
•
ill be subject to a penalty.
Noise Ordinance In Effect: DAY - FRIDAY Before 7 a.m. and after 10 p.m. Weekends/Holidays before 7 a.m. and after 8 p.m.
SIGNATURE OF APPLICANT: aidADATE:
08/17/17
PRINTED NAME: Bethany Aved J
This is the signature of: ❑ Owner or ❑ Owner's Representative
OCCUP. TYPE: CONST. TYPE: CODE:
BLDG SPRINKLED Yes ! No
VALUATION: $ 7,365.00
Permit Fee: $
WAC Charge: $
Plan Review Fee: $
Sewer & Water Hook -Up: $
State Surcharge: $ -
Sewer & Water Disconnect: $
Site Inspection Fee: $
Water Meter: $
S.E.C. Fee: $
Muni SEMA Fee: $
J
Investigation Fee / Other Fee: $
Copy Charge ($.25 per 8.5 x11 page) $
*2016 SAC Escrow: 85
Other:
z
License Check ($5) / Lead Check ($5) $
TOTAL DUE: 7
W
SUB -TOTAL $
Plumbing Fee (from Page 2) $
`NOTE: Commercial plans will be submitted to the cs
for SAC determination. Escrow payment will be required when permit is issued. If
Mechanical Fee from Page 2 $ 0
after Met Council review no SAC is determined, escrow will be refunded in full.
LL
Special Conditions/Required Setbacks:
O
Building Approval By:
DATE:
Printed Building Approval By:
❑ License Verification ❑ Lead Verification - Checked By:
City Approval By:
DATE:
Paid: d Date: oty Receipt No.
L 13b By:
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CITY OF SPRING PARK ❑ MECHANICAL PERMIT
❑ PLUMBING PERMIT
PAGE 2 FOR PERMIT ISSUANCE
PAGE 1 and PAGE 2 should be complete
MECHANICAL INFORMATION
Mechanical Contractor: Twin City Fireplace & Stone OAddress: 6521 Cecilia Circle
city: Edina state: MN zip: 55439 Phone: 952.7 7.412 Fax: 952.942.2093
State Bond No: MB682977
lContact Name: Beth Ayers
Email: beth fltwinci Ireplace. com
lContact Phone: 852.777.4125
Detailed Description of work: Install two gas fireplaces Town & Count 42: Mendota FV46
Indicate type of project, fixtures, and Gas Lines you will be installing or replacing (include count for each type of fixture):
MECHANICAL FIXTURES GAS LINES
Quanity Quanityuani
Furnace Kitchen Fan Furnace
Air Conditioning System Bath Fan Fireplace O - as work done by
Air Exchanger Grill Unit Heater builder contractor
2 Fireplace Water Heater
Unit Heater Grill
In Floor Heat Dryer
Gas Log Stove
Office Use Only:
❑ Replacement (one fixture only, no piping or vent changes) Mechanical Permit Fee: $ 77.00
❑ Addition/Remodel Gas Line Permit Fee: $ -^
cXNew Construction State Surcharge: $ 1.00
❑ Other Other: $
Total Mechanical Permit: $
= INFORMATION
PLUMBING
Plumbing Contractor: Address:
City: State: Zip: Phone: Fax:
Plumbers License No:
IState Bond No:
Contact Name:
I Contact Phone:
Email:
Detailed Description of Work:
Indicate type of project and fixtures you will be installing or replacing (include count for each type of fixture):
PLUMBING FIXTURES
Quanity Quanityuani
Water Heater 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
Lavatory ash Basin Bathtub
Office Use Only:
❑ Replacement (one fixture only, no piping or vent changes)
Plumbing Permit Fee: $
❑ Addition/Remodel
State Surcharge $
❑ New Construction
Other: $
❑ Other
Total Plumbing Permit: $
DEPARTMENT OF
LABOR AND INDUSTRY
License/Certificate/Registration Detail
Class Type: MECHANICAL CONTRACTOR BOND Number: MB682977
Application No: 337669 Status: ISSUED
Expire Date: 7/30/2018 Effect Date: 7/30/2016
Orig Date: 6/27/2014 Print Date: 8/1/2016
Enforcement NO
Action:
Workplace N/A
Experience:
Name: TWIN CITY FIREPLACE & STONE COMPANY
Address: 6521 CECILIA CIR
MINNEAPOLIS , MN 55439
Phone: 952-777-4125 Fax: Other:612-282-2684
Name: Lic/Reg No:
Status: Application No:
Expire Date: Effect Date:
Orig Date:
Business Relationship Requirements
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