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Home My WebLink About2011-01285 - mechanical � ` CITY OF ORONO PERMIT NO.: 2011-01285 � » " 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 10/20/2011 , 952 249-4600 FAX: 952 249-4616 ADDRESS : 1930 SHADYWOOD RD PIN : 17-117-23-24-0022 LEGAL DESC : SHADY-WOOD : LOT 000 BLOCK 000 PERMIT TYPE : MECHANICAL(>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : MECHANICAL-MULTIPLE VALUATION : $ 6,100.00 NOTE: 1 LENNOX NAT GAS FURNACE 1 LENNOX 2 TON AC APPLICANT MECHANICAL 76.25 MARSH HEATING&AIR COND STATE SURCHARGE MECH(VALUATION) 3.05 6248 LAKELAND AVE N MINNEAPOLIS,MN 55428- MAIL-IN FEE 2.00 (763)536-0667 TOTAL 81.30 OWNER ELMQUIST,DAVID A 1930 SHADYWOOD RD ,MN 55391- AGREEMENT AND SWORN STATEMENT 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 governing this type of work shall be compied with whether or not specified herein.This petmit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if consVuction 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 wit}Lthe State Building Code.This permit may be revoked at any time for due cause. � `�vt�t-c�P Lr- l l l l Applicant Permitee Signature Date Issued By Si ure e SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. , � _ 1 � � vO ��' � t� FOR CITY USE ONLY ��,�` City of Orono � �O4 `rO P•O.Box 66 Date Received: Permit# #�,�., 2750 Kelley Parkway � �{xr��. � Crystal Bay,MN 55323 Approved By: Amount$: �s��o Phone(952)249-4600 Fax(952)249-4616 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 RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3. Mechanical Desi�ns—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. 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 finai. TYPE OF PERMIT Check All That A 1 �Residential ❑Commercial(Approval Required) ❑ New ❑Additional ❑Repairs 0 Replace Job Site/Owner Information: Site Address: � �JU ��1�U[.C� , Owner: Mailing Address: l9� c��2�G(X�G� � c�Ty: I�✓'UY�D z�p: .55�1 / Home Phone: q �Ja` 4��" g�� Alternate Phone: Contractor Information: Contractor: (�QY_��1.C'�'f KG��'�Contact Person: �'1G! �(� I, tGU �'1 "'",�/ Address: (��IG(Y�14�1°�State Bond#: ?J' S �J �' City: �� AY'CZip: � Expiration Date: g�a 0 /�02- Phone: �(n?J'�J'�J(Q��7 Alternate Phone: ❑ Insurance—Current: (, 1 . , � . � �, MECHANTCAL SYSTEIV�S BEING INSTALi�E�r i Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. IS THIS GEOTHERMAL? ❑Yes 1 No HEATING SYSTEMS Quantity: � Make: �y��'� Model: r�(p��pV,�Q�? r Fuel: 7'. Flue Size: Input BTUs: �� Output BTUs: � CFM: COOLING SYSTEMS Quantity: � Make: �(/71'lQx Model: x(��d a►� Tons: H.Power FIREPLACES ❑ Gas Factory Fireplace Brand Name: ❑ Wood Burning Fireplace ❑ Wood Stove Model No.: ❑ Wood Stove with Flue/Masonry VENTILATION ❑ No. Kitchen Exhaust duct recirculating cfm ❑ No. Bath Exhaust(must have duct outside) cfin ❑ No. Other Fans: Locations cfm 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: 2 _ , , . . PERM�T FEE CALCi�ATICJN f S� ` ' ` BASED OFF-2002 ST��E STA� ❑ Yes,this section applies The replacement of a Residential fixture or appliance that meets all three of the following requirements: 1. Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and 3. Is improved,installed or replaced by the homeowner or licensed contractor. Skip next section,if this applies; Cost of Permit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ PERMIT FEE CALGIJLAT�ON S -3QBS OVER$SQO.OU If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) (p�� x A125$ �[o . ,�� (contract price) (mimmum$50.00) 2. STATE SURCHARGE / �b� �O x.0005 $ ,3�D � (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ l� �C.J ■ * 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 installations 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. MECHANICAL PE1rMIT APPLIC.ATIQ�T:p►��M�NT } 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: Reset Form � 3 �� i Client#:13152 MARHE DATE(MNUDD/YYYY) �tCORQ,., CERTIFICATE OF LIABILITY INSURANCE 3/31/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate dces not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: EPIfl SU�b@� J.A.Price Agency�I11C. PHONE 952 944-8790 ac N, EM: ,vc,No: 952 944-0097 6640 Shady Oak Road ADpR'E�, erin.surber�japrice.com SUIt@ rJOO INSURER(S)AFFORDING COVERAGE NAIC# Eden Prairie,MN 55344-6176 ,NsuRER,,:Cincinnati Insurance Companies INSURED iNsuRER B:Accident Fund Insurance Co.of 10166 Marsh Heating&Air Conditioning Co Inc INSURER C: 6248 Lakeland Avenue North INSURER D: Minneapolis,MN 55428 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR NPE OF INSURANCE NSRL WVD POLICY NUMBER M�D/YYYYF MM�/LD�DNYYY LIMRS q GENERA�u^eaiTM CPPCPA3650927 MO�IZO�� 04�O�IZO� EACHOCCURRENCE $� OOOOOO X COMMERCIAL GENERAL L�ABILITY PREMIBES EaEoNccTurrence $5O OOO CLAIMS-MADE �OCCUR MED EXP(Any one person) $�J OOO X PD Ded:500 PERSONAL&ADV INJURY $� OOO�OOO GENERALAGGREGATE $Z�OOO�OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $Z�OOO�OOO POLICY X PR� X LOC $ A AUTOMOBILE LIABILITY CPPCPA3650927 4�O��ZO�� OMO'I�ZO� Ee axideD SINGLE LIMIT ��OOO,OOO X ANY AUTO BODILY I W URY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ X H REDSAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ A �( UMBRELLA LIAB pCCUR CPPCPA3650927 MO�/PO�� O4IO�/ZO1 EACH OCCURRENCE $.3 OOO OOO EXCESS LIAB CLAIMS-MADE AGGRECaATE $$OOO OOO DED X RETENTION$O $ B WORKERSCOMPENSATION WCVGOZ9rJ'IB 4/01/2011 OM01/201 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y�N E.L.EACH ACCIDENT $SOO OOO OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $SOO OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $SOO OOO DESCRIP710N OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space ia requlred) CERTIFICATE HOLDER CANCELLATION Clt Of O�Of10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O.BOX BB ACCORDANCE WITH THE POLICY PROVISIONS. Crystal Bay,MN 55323 AUTHORIZED REPRESENTATIVE W�,ye.� �1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 pf 1 The ACORD name and logo are registered marks of ACORD #S69419/M69345 ENS C��' DAT TIM E CITY OF ORONO CALLED IN � �l INSPECTION NOTICE SCHEDULED // �� PERMIT NO.��/��O�2� COMPLETED ADDRES � � OWNE T LEP NO��'JG7�—S�� CONTRA TOR ~ >; DESCRIPTION � � � —�r:�'�GU� W ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING `� � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y O ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ P NG RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL OWNERICONT TOR TO MEET YOU:�YES_NO � COMME � .� �/l �a5�3 5 - � � � J O a � O � W � Q � Z W � W � � GW ❑WORK SATISFACTORY:PROCEED �PROJECT COMPLETE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDIT�ONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN �STOP ORDER POSTED.CAIL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (g52) 249-4600 OwnedContractor on site: � Inspector. �� White Copyllnspector's File Canary CopylSite Notice