HomeMy WebLinkAbout2012-00192 - gas fireplace CITY OF ORONO * 2 0 1 z - 0 0 1 9 2 *
' 2750 KELLEY PARKWAY DATE ISSUED: 03/14/2012
` ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 2900 DEER RUN TR
PIN : 04-117-23-24-0013
LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN
: LOT 008 BLOCK 004
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTI01�1 TYPE : FIREPLACE-GAS
VALUATION : $ 3,200.00
NOTE: HEAT N GLO PALOMA-MOD
APPLICANT MECHANICAL 50.00
FIRESIDE HEARTH&HOME STATE SURCHARGE MECH(VALUATION) 1.60
2700 FAIRVIEW AVE
ROSEVILLE,MN 55113 MAIL-IN FEE 2.00
(651)633-2561 MISC FEE 0.00 �
Minnesota State License#:20512060 TOTAL 53.60
OWNER
KACZKE,ROBERT&JILL
2900 DEER RUN TR
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be perfortned according to
the approved plans and specifications,appiicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
�-yK.�-� �- l � ��ryt,.�� / /
Applicant Permitee Signature Date Issued By S' ature ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB
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FOR CITY USE ONLY
' A- City of Orono
¢O`�' ' P.O.Box 66 Date Received: Pem�it#
� �`'` 2750 Kelley Parkway
� �i` * ��� Crys[al Bay,MN 55323 Approved By: Amount$:
�°� • o` Phone(952)249-4600 Fax(952)249-4616
���osi�<:
CITY OF ORONO—MECHANICAL PERMIT
(All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall)
GENERAL INFORMATION
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 two working days.
2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT
VALiD UNTIL YOU RECENE A PERMIT. WORK MUST NOT BEGIN UNTTL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical Desiens—Complete calculations,details and specifications are required for each
heating,ventilation,humidification-dehumidificatiou,and air conditioning installation including
heat loss/heat gain calculation,design temperatures,equipment ratings and identification as to
type,manufactwer and model. Data shall be presented on form 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(952)249-4600.
(24-48 hour notice required)
7. House Heating Test Record must be submitted before final.
TYPE OF PERMIT
Check All That A 1
�Residential ❑Commercial(Approval Reyuired)
[�New ❑Additional ❑Repairs ❑Replace
/�
Job Site/Owner Information:
Site Address: o�9v'U Dee� �u� �/' •
Owner: � �� �a c z K C Mailing Address: �9 vt, ��er �K� �l'.
City: dl'o n o Zip:
Home Phone: 7�i,3�,f�g- �9°7 Alternate Phone: ���-���O' 9SgS I�A�)
Contractor Information:
Contractor: Contact Person: HEARTH & HOMF TECHNOLOGIES, INC.
a TH & HOME
Address: State Bond#: Lic. BC0512060
VENUE N
City: Zip: Expiration Date: ROS��,L���M 561 113
Phone: Alternate Phone:
❑ Insurance—Current:
1
' '1.
�
` J!VIECHANICAL SYSTEMS BEING INST�LED .
Note:All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS TffiS GEOTHERMAL? ❑Yes ❑No
HEATING SYSTEMS
Q�rity:
Make:
Model:
Fuel:
Flue Size:
Input BTCTs:
Output BTCJs:
CFM:
COOLING SYSTEMS
Quanrity:
Make:
Model:
Tons:
H.Power
FIREPLACES
� Gas Factory Fireplace Brand Name: �+G�T� �+(�
Wood Burning Fireplace
❑ Wood Stove Model No.: p�►�O M r.—� j✓I D I�
❑ Wood Stove with Flue/Masonry
VENTILATION
❑ No. Kitchen E�chaust duct recirculating cfm
❑ No. Bath Exhaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfin
FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.)
❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside
LP Gas: gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill ❑ Other/List What&Where:
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PERMIT FEE CALCULATION(S)
BASED OFF-2�12 S"TATE STATUE
❑ Yes,this section applies
The replacement of a Residential fixture or appliance that meets all three of the following requirements:
1. Does not require modificarion to electrical or gas service.
2. Has a total cost of$500.00 or less;excluding the cost of the fixtute or appliance:and
3. Is improved,installed or replaced by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Permit $ I5.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $
PFsRI�'.FEE CALCU�ATI4N S �-�JBS 4VEIt.�SUO.UO
If above does not apply;follow guidelines below:
l. CONTRACT PRICE *is 125°/a of contract price with a(Minimum Fee of$50.00)
3��.vt� X.o�2s$ 5�0.vt�
(contract price) (minimum 550.00)
2. STATE SURCHARGE
3�0'D.�,T� x.0005 $ l. Co D
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ .s.3.�O
■ * 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 chazged
to the customer for the work done. If any material,equipment,labor or installarions are furnished by
the owner, tenant or any other party, 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.
IV�CHA�3��1�;L`PE�1�A�T��LIC�lT�C31�A+CiR;EEMLIV'I' :
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 State of
Minnesota, and certifies that all statements made on this application are complete, true and
correct.
Applicant's Signature: -`�� Date: � /� 02
R@$+@t fCH"17i
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