Permits - Permit# 98-15M - 4309 Channel Road - 1/1/1998CITY ::OF'SPRING PARK
BOX 452 (4349 Warren Avenue)
Spring Park, MN 55384
/D/
APPLICATION FOR MECHANICAL PERMIT
GENERAL INFOILNL4TION
1. You may apply for mechanical permits by mail or in person at the City offices. Applications will be
reviewed and a permit will be issued within 2 working days.
2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT VALID
UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS
POSTED ON THE JOB SITE.
3. Mechanical Designs - Complete calculations, details and specifications are required for each heating,
ventilation, humidification -dehumidification, and air conditioning installation including heat loss/heat gain
calculation, design temperatures, equipment ratings and identification as to type, manufacturer and model.
Data shall be presented on form provided. Identification of and specifications for water heating equipment
shall also be provided.
4. When any new construction or remodeling is involved, a separate building permit must be obtained.
5. All work must be done in accordance with the Uniform Mechanical Code/State Building Code
requirements.
6. All work must be inspected (rough -in and final). Call 473-7357. 24-hour notice required.
7. House Heating Test Record must be submitted before final.
Instructions Complete all items on this application. Compute the permit fee. Sign and date the certification.
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call 473--73577,, 1r
Please check one: New Addition Repair Replace
Residential Commercial
JOB SITE: Zip:
Owner's Name- W Telephone Number: y 7 i- '�3 -7
Mailing Address: i43,42(1 City: 5 r1,n7 ( Zip: ss 3a1
Contractor'sName: P('Ac4 ; c k 1 TelephoneNumber: 4qP8 J 82 6
MailingAddress: i y l 2 to Auveyv 'A , City: ,_rs Zip: 55,5 7q
SYSTEM DESCRIPTION
HEATING SYSTEMS
Quantity:
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H. Power
WOOD BURNING EQUIPMENT
Wood stove with flue
Wood combination or add -on
Factory fireplace with flue
Factory Fireplace (s) Freestanding
Wood Stove (s) Franklin, other
Masonry
Brand Name Model No.
Mfgr's Min., Clearances, side rear min. flue dia.
Total
VENTILATION
No.
No.
No.
Kitchen Exhaust ducted
Bath Exhaust (must be ducted outside)
Other Fans: Locations
recirculating cfm
cf n
cfm
Total
FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
Installation Removal
Fuel oil: gallons underground
LP Gas: gallons
Other —
inside
Gas opening
outside
PERMIT FEE CALCULATION
1. 1.25 % of Contract Price* or Minimum Fee ($35.00)
�zz� x .0125 $
(contract price)
2. State Surcharge. ** Add the State Building Code Division _
Surcharge to each permit. /TGz x .0005 $
(contract price)
or $.50, whichever is greater
3. Postage and Handling . (Only mail -in applications) $ —
4. TOTAL PERMIT FEE (Add lines 1-3 above) $
CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted
work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
customer for the work done. If any material, equipment, labor, or installation are furnished by the owner,
tenant or any other parry the reasonable market value of such items must be added to the estimated cost
or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,
the City may request the submission of a signed copy of the actual contract.
** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do
all work in strict accordance with the ordinances of the City and the regulations of the Minnesota
State Building Code, and certifies that all statements made on this application are complete, true
and correct.
Applicant's Si Date: / �L
PP �
Approved By: Date: