HomeMy WebLinkAbout2015-00401 - gas line only CITY OF ORONO * 2 0 1 5 - 0 0 4 0 1 *
'" 2750 KL+'LLEY PARKWAY DATE ISSUED: 04/09/2015
, ORUNO, MN 55356-
952 249-4G00 FAX: 952 249-4616
ADDRESS : 2474 SANDSTONE LA
PIN : 33-118-23-11-0027
LEGAL DESC : STONEBAY
: LOT 024 BLOCK 001
PERMIT TYPE : MECHANICAL(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : GAS LINE ONLY
NOTE: REPLACE EXISTING GAS FOR COOKTOP
APPLICANT MECHANICAL(<$500) 15.00
STATE SURCHARGE MECH(<$500) 5.00
FRIENDLY HOME SERVICES MAIL-IN FEE 2.00
7510 LANNON AVE NE
OTSEGO, MN 55301- TOTAL 22.00
(763)331-1274 Payment(s)
Minnesota State License#: mech-MB676827 CREDIT CARD 1494 22.00
OWNER
OINES, LESLIE
2474 SANDSTONE LA
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMEIv'�
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable 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.
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Applicant P rm tee 'g a ure Date Issued By Signature Date
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���'"` City of{3rono
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����-�,�,s��,���' +L"ITY Cl� f:)R(JNQ—M�:C'HAN�I+�AL �'�It1��IT
___ (Atl C��+��m�rcial�rermiLs rnusC ba appr�>ved by the f3uit�fir�g t�fi�cisi or l�tspectur��ndfor Fire t�4:irshati)
i GE�1ER�.I1 II`JF�'{)RIVII�TIC}N __� �1
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i. You may a�rply�for m�*chanical�ermits k�v rnait c,r iri person at the City�a�f6ces. Applicatio��s wilI
be revi�we�and a permit wiil be issued u>ithin twa working days.
2. t'errnit cards wilf be sent by r�tti�rn mail after a revieti�� is cc�m}�Ieted. PGRMITS AFZ�NC)"I'
VAL,I�D UNTiT,YCJU I�EC;EIVF.,� P�ftVIiT. 'Ukrt}�2K I�ICIST pJ{Yf' �EGTN UNTIL THE
PERMiT CAt2D TS POST�:i3 4N THE JOB S1TF.
3. Mcchanica:I 27esi�ns—Complet�caleulations,defa�ils and speeiticat�ic�izs arc requir�d fc>r each
heatin�;,ventilat[on,humidificatiatt-dehurr�it3ific�tian,and air conc�itioning inst�allation inclading
heat ic�ss�heat gain calcutati�n,design ternperat�ures,equipm�i�t ratir�gs and identitication as to
type,manutacturer and mndel. Data shall be�resented c��� fc�r�z��rvvided.
4. When any new eonsfin�ctian ar remodefin�is involved,a separat�buitding perrni�t must be
ot�tained.
5. AlI work inust be done zn a.cec�rdance wifh the IJnif�rn� Mechanical CodelState Suilding Code
rec�a irernents.
6. Ali wc�rk rnu'st be inspected(rough-in a��d�inai}. Cail(9S2)2�#9-4600.
(2�-48 h�ur notice reqaired)
7. Hause Hc��ting"1`est Recc�ccl must he subr��i[t�:d�Sefore fir�aJ.
� '�"��`��� �����'
(Chec���� "I'hat 1�pp1� �
�Resici�ntial []Corrimerciai(Approval ftequirecl)
Q Neu� (�Ade�itional ❑ Repairs (�,R�eplace
Job Sit�/tJ�vner InfQna�ati��n: �
Site Address. .� �"�� ,�``� �,��;.,,c� ����d�.-e-_ C.. �✓t_.�..�..
t)wner;. � i'O�Iailing �ddress;
Ciiy: 7ip;
Hc�me 1�hQ��e: ��4"�: ._ ���i ``i ` �> :�"%,,� Alternate �'hr�ne:
Contractar I�lformation:
r , , t' � ,�,.__ ,
ConlractQr: �; � ���r,<<;� i��. � ,�'j���,: .�t��vr .�;�'�.:�antact ['ersoz�; fr �=�--�� �� �s # ___..._.
Address: i`� f R."; t_-�z.�-�,�-t�,}� �' �'�' ����. State I3ond�: ,�r��� fj`{ �$'s� ��
II
Cit}F: ,'��-� c�?r"�;; �i� �--��,„�.�� Expiration Uate: �� ' �,`'`�� t ,`.�
�
F'h�ne. ��, � _. .�� r�- .� �, c�,i� �ltert�ate Phe�ne: _��� z� :��1 -- �..) ;�t�
[] �nsuranc�—Current: �� � ; '�_..g r
1 ��
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? s�. ,yW� �� �5 �,'• � � a .
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, 1'Vate:All Geothermal Systertzs will now require a Site Plan&Review by our Buildin�Official.
IS THIS GEOTHERMAL? -(�Yes �No
HEATING SYSTEMS
Quantity: ___ __ ��.�._
Make: ._._.....__
Model:
Fuel:
Ftue Size: �
:tnput BTUs:
fJutput B1'Us: �
CFM:
Ct3�I,ING SY'�T�MS
Quantity:
Make:
ModeL �
Tons:
H.Power
FIREPLACES
❑ Gas F�ctory Fireplace Brand Name:
❑ Waod Bumin��ireplace _ —_.._.,
❑ W[SOd StOVe Model No.:
�.....
Woo�Stove witl°�Ftue/Masanry
VEN'�;LAT�4N
❑ No. Kitchen Exhaust duct __recirculating cfm
�.__
N0. ........____..._. Bath 8xha��st(must have duct autside) 1 Cftri
❑ No. .._.._____ �ther Fans: Locations_._.... �cfm
k"[JEL STQR,,�G� (Must be approved by,�"ire M�rshall if prapr�xing tn aba�t�lvrr tartk in plac�)
❑ Installation ❑ R.emoval
Fue(Oil; gat2ans ❑ Undergraund [�lnside ❑Outside
LF Gas: � ..____..�gallons
4ther: _ ...._.__._.�_._
GA�LINE 41VLY
❑ C?utdoor Gril! � f.hher(List What&Where:_/��L�$ ��' � ��"�,�
2 � � s �.c�����
�'C�'�,�.,�k�a�����'"xaa �f� a^�a�����1
� '�,�,�,}��,���r �'�d," ��,y�a���?pi� g��j�� ,�� v a; k �� ;f'+v ���k��������� s��� � �ro��.&
� � q ���F � g � k ��} � .�
� � � ��N ��K'� 3 m���;�,
��,"��,��.�� �� R,,�'�� a �
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� Yes,this sectian applies
Ths replacement af a.Residential fixture or ap�ian�that meets all three of the fol lowing requirements:
I, D not r�uire madification to electric�l or gas service.
2. Has a ta t co af�5{}(?.00 or tess;exclu�the cast of the fixture or appliance:and
3. Is irnproved,installeci or replaced tay the hameownar ar�ieensed contractar.
Skip next seatann,if this eppties; Gost o.fPermit $ l 5.04
Stare�urcharge � 5.�
Mai(-I.n Fee{IfApplicable) $ 2.�p
Totai Permit�'ee g; �p��
,t:�"y �.tiF 3 '-s,.Sy �;
HN 5?3� .t�,;q��'��w�y,P�., � M1 � _
....
, . �- - X .,�,
���'�` � �`° +��
�� If abave does not applY;fotlow guidelines belc�w:
1. CQNTRACT PItiGE *is I.25%ofcontrac.-t price with a(Nienimum Fee ofa�SQ.pQ)
xAl2S$
{cot+ttaCk pnt�} � {fnFnimum�.i0.0U) ��
2. ST�,TE SURC�I.4RGE
�.....� x AOOS $
{contract price) . —"�"_
3. FdSTAGE&MANDLING{{�n�y o����-�n Appticatians} � 2A0
4. TOTAL P�RMI7'FEE(Add Lxnes t-3 At�ve) �
' * C4NTRACT PItIGE at JQB GC1ST means the actuai or es�rimated dollar amount charged far the
permitted wark including materia�s, labar,profit,and o�er fiaced costs. lt is the amaunt to be charged
to ihe customer for fihe work cEone. �f any material, equipmerft, labor or installat�ons ar.e furnished�y
the owner,tenant or any other party,the reasonahle.market vatue of such item.s must be added to the
estimated cost or contract price for pernait fee puxposes. In tihe evant that there is a dispute an the
amount of the job cost, the City may request the submissjtin of s signer! copy of the actual contract,
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The undersigned hereby a�plies to the City for issuance of a Mechanical permit, agrees to do all
wock in strict accordanee with the ordinances of the City and the regutat�ons of the State of
Minnesota„ and certifies that all staternents rnade on this appiication are complete, true and
correct.
Applicant's Signature: ,�� Date• �
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