Permits - Permit# 04-20M - 3826 Budd Lane - 1/1/2004FROM C17Y OF SPRING PARK UF? 9 28 2004 i0; 9/ST.10;38lK!0.50114i52G5 P 2
CITY ,OF SPRING PARK
4349 WARREN AVENUE y
SPRING PX1 K, MI"ISOTA 553344
952-471-% 51
APPLICATION ]?OR M]l;CHANICAI. PERMIT
1. Yaa may apply fbr mechankA permits by ma7 or In pefaon ut the City offices. Appiketioms will be
reviewed and a permit will be issued within 2 vverkluig days.
2. Permit cards will be sent by return mall sd'ter a reAev, is completed. PZRMTCi ARE NOT VALID
LINTEL YOU RECEIVE A PERMIT. WKIRlf N11191 NOT ILON 1111113, 11HEMULMMEARP-M
pomp JODI In J03,SEEL
3, mats..-"! DWk &- Complete celcaldkiiis, details and speclf adws an rdlnired for eacb
heatiM boa, humidilicatien-dehouddification, and ah- coadlt oeft insbdlatlon fnchidi g, heat
Imslheat gain calculation, design tempera.tnres, egaipsaemt r A0W sad ideatifleatlom as to type,
manufacturer and model. Data shall be presented oa :form provided, Ideadficomen of and
sp effications for water beating eg4mar sbell also to provided.
4. Wben any new con0mcdon or remodeling is Involved a separate budding person mtW be obtaleed.
S. All work mint be done In accordance wide the Uaffuris Mechanical Cod"Rate lstmlding Code
regtdrementa
6. All work must be inspected (rough -in wW1 final). Can "2-249-4690. A 24 bolo' notice is regtdred.
7. House Henna` Tear Record mn& be submitted before Bad,
INSTRIjC=hM Complete ail items on this sy*lleadon. Compute the permit fee. Sign and date the
certification. INCOMPUTE APP'LICA710PiS WILL NOT BE :PROCESSED. If ;roa have dons,
sap 9$2-249.46M or 952-471-"S1.
Please check one: New V Addiction Repatir —_ Rephsce
Resldoatiai. ✓ Coatumiercisi
JOB
Owner's Name Su s ,4NN 4 ?ohm �'`%N Phone Number _ 76 3 - -2- 9 7 - s b z S
MrAft Address 3 4 Z 6 d J LAAl fi 2 y _f? 0 -q-S 3 9 y
Coatraet�or's Name
_ He.,a t v g � ���� f�J _ Phone Nun her 9�B - 5/ 7L 7
IY wrong Address -o I 111"', Aj Sw, °'1 c /hN Zb o 7/
HEATING SYSTEMS
Quantity
Make
Model
Fuel
FUN size
input BTUs
Outpost BTUs
CpM
COOLING SYSTEMS
QMWO
Make
Model
Toms
IL Power
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Aachwiicttl Parent
'W'v0d stavt- with hue
W o4w co'lulul,at Oa Jar
'Factury iirtplact *hth hue
PI&CtOTY IIMPlmtt(S) __ _ _-- t~5re�� ifnelillvmt PvgaP,r+ar�
wood ewive (s) _ _ _ Franklin, other
Nj[i &r''is Min., cleaarance4 sidir rears � ula. tyade this
Too
a'EN T tji,FlTION
NaL -_-- Kittheu erimt t - ducted reeirukllitint; _ rf]m
Nil, off- Nairn, e—xhuu,er (mi at h! ducted outside) —efan �x L O �/+C 70
Other Las: 1.@ca60136 wilt
PULL SYkai[LNGS (NHJS"r DE APPROVED til' Fi itf; iVlJUWMU,1.BL)
YMSCA14dda —ikeuesovil __
7r'r►c!1 Oil _ � __-- gadons __ asuderVrouald ,_..,... inside --- outside —
LF G" _.__ i;-Wow ,—
O' dicr -- — --- �.�. _ .W.. _ gas 6ptniu _
'et,This Section Applics
Y he repka4rommetil of g fiuid nti d that mrcts mpi that of the fntlmwing requimments:
1) 1kan a requlrt; naudWkatialta to eleciHeol or gas:ervim
2) Do a =Lmd or $ .00 or left a1Ji , tsar co;d of th'. t nure or appli0kce; aad
;i) Is ietypromed, inatxtled or rrprliaced by the hwo seer or iicenwd contractor,
skip newt ",.tiop; Cost of 1?ermit S —VISM _--
State sorcha qa S
Mad In Fee S_
i. r.a:5"io of f'Qai g t&r� °.or
3q 71x .01ZS 5� --3�._
(t: a►mmtsaa Price)
2. SiLft Sear 'e W •• Kidd tlfie Stain 10ssilailisapf Code Didisiod
Surchuge to each permit -_ -3'1 7 L3 — I --
(Contract Price)
nr S-SC, whia_lhev,er h greater'
3. fk1 A d Had ling (Odle tu0e ll-tn apsF'li¢atstrne) S. 1. 1__—_
4, TO'fl'AL FERNW FRE (Add lanes 1-3 ed)ove) $�_ �SL � 90
CONTPuCT ]?'ItICE or JOID COSH' means the actual or vokwated dollar affi unt chasgeal for tihe
permitted wtlrk including materials, Iatwr, profit, %&I other fla-ed coats. It is 0+ e amount to be charged
to tLe ciautomer f(W the work done. If any aaa"ml, equipment, labor, or instal latioa "t furnished by
dac owner, tenant, or any other party, the reasonable market value ol"such ltesms mug be .addedto W
cstimma"ced rust or contract price for pemilt ree purpow. In the event there is it iilsp-eute on the asnount
2
0.; T r ��r I : G L 0 "1' PARK TUE9 2004 1
1\1calw1k� F maut
of the job cuA the City may request tbt:;�&bmlssloa of a signed copy of the actual contract.
The STATE SURCHARGE is .005 Of th': c0Rt"zctprice Un'1CF $1,000,000or 1;,50,whkhcvcr is
greater. For valundens over $1,000,000 call the Deportment Of lowedonal Services fur the
price.
The va4ersigned hereby applies to the CRY for kwance of MtCiUW1C&1 Permit, &V r"s to do all work
In strict accordaact with the ordinances of the City and thi regulations of theINAUD-160ts State Building
Code, and certifies that all statements made an this appiltution we complete, true amd correct.
Apphtant'o Shmature. 4flO -7, Aaa-) Mate —A10 j/
Approved By -1we —
......... . ............ Building Codes and Standard Divisio
Commissioner of Administration
Has Received and Filed a $25,000 Surety Bond,
As Required by MS 326.992, for Work Regulated
by the State Mechanical Code
To- Scott Hass Bond No: 55-191800
H & H Environmental Solutions dba MB ID: 00757
Heating Consultants
201 4th Ave. S.W.
New Prague MN 56071
Effective Date Expiration Date
10/16/2004 10/15/2005
3