HomeMy WebLinkAbout2000-P03028 - mechanical PERMIT
C,�•I�`�`Y O F O RO N O Permit Number:
2750 Kelley Parkway - PO Box 66 Po3o2s
Crystal Bay, Minnesota 55323 Permit Type: Mechanical Permits
(612) 249-4600
Date Issued: 9i26�2o0
SITE ADDRESS: 2000 Shadywood Rd ,
WAYZATA,MN 55391
P I D: 17-117-23-31-0001
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Mechanical Permits Permit Sub-type(s): Heating Systems
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 2,322.00
State Surcharge Fee: $ 1.16
Misc.Fee: $ 1.50
TOTAL FEE: $ 37.66
APPLICANT: SEDGWICK HEATING&AIR CONDIT OWNER: ROGER&LUCILLE kIRCHNER
8910 WENTWORTH AVE SOUTH 2O00 SHADYWOOD RD
MINNEAPOLIS,MN 55420 WAYZATA MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND
STATE OF MINNESOTA BUTLDING CODE REQUIREMENTS.
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APPLI ANT PE ITEE IGNATURE � SUED BY SIGNATi.JRE
Copies: City,Applicant,Assessor, Finance Page 1
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CITY OF ORONO APPLICATION FOR MECHANICAL PERMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, 1Vni 1 55323 � F}; -
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GENERAL INFORMATION � - t,,. , .r�
1. You may apply for mechanical permits by mail or in person at the City offices. Applications will be
reviewed and a pemut 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. i'�'�
3. Mechanical Desi�ns - Complete calculations, details and specifications are required for each heating, �
ventilation, humidification�ehumidification, and air conditioning installation including heat loss/heat gain
calculation, design temperatures, equipment ratings and identification as to type, manufacturer and modeL :'a
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 249-4600. 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 249-4600.
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Please check one: New Addition Repair °� Replace
,/ Residential Commercial ' r
JQB �I'I'E: �• � , ` �� �,�� ,�`; �ip: �;
Owner's Name: Telephone Number: �;��/.� �j/�/� r
Mailing Address: �. -'.�x�i:... City ,�'��.« � Zip; �.���
Contractor's Name: �,:�;,.,,,«,�;W, . , Telep e Number: �'��-�df��
Maii�ng Address: 89�Q�,�'�eg�R:c;��'?e�venue S�o�atfCity: Zip:
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SYS'I EM DESCRIPTION -
HEATING SYSTEMS
Quantity: r
Make: ��
Model: - S�
Fuel:
Flue Size: ( ''
Input BTUs: $' •
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H. Power
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WOOD BURNING EQUIPMENT
Wood stove with flue
Wood combination or add-on
Factory fireplace with flue
Factory Fireplace (s) Freestanding Masonry
Wood Stove (s) Franklin, other
Brand Name Model No.
Mfgr's Min., Clearances, side , rear , min. flue dia.
VENTILATION
No. Kitchen E�aust ducted recirculating cfm
No. Bath Exhaust (must be ducted outside) cfm
No. Other Fans: Locations cfm
FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
� Installation Removal
Fuel oil: gallons underground inside outside
LP Gas: gallons
Other Gas opening
PERMIT FEE CALCULATION
1. 1.25%o of Contract Price* or Minimum Fee ($35.00)
:,�,�,� x .0125 $
(contract price)
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit. x .0005 $ /. /� �
or $.50, whichever is greater (contract price)
3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �7.�, 7
* 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 fumished 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 pernut 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 51,000,000 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 Signature�/ ' Date:
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Approved By: Date:
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DA��, �TI��
CITY OF ORONO CALLED IN u.�
INSPECTION TI�E SCHEDULED � - �
PERMIT NO. `J��'�� COMPLETED '� ����
ADDRESS �L�% ���C ��� C"
OWNER CONTR. c�l�.�-=iC.l�-
TELEPHONE NO. �S�' - �'�'� ��6Z'�-'
� DESCRIPTION
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FI�LING
� 02 FRAMING �t'i MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTAI.L. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINA� 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W�WORK SATISFACTORY:PROCEED �OJECT COMPLETE
� ❑ CORRECT WORK&PROCEED :_ ISSUE CERTIFICATE OF OCCUPANCY
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0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Cali for the next inspection 24 hours in advance. 249-46��
OwnerlContrac o n site:
Inspector.
Whiie Copyllnspector's File Canary CopylSite Notice
SEDGWICK HEATING & AIR CONDITIONING CO. TEST RE'CORD �OB NO.J����c��
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 • (612) 881-9000
ADDRESS �Q V� -S �-'�- ��. GGE�c � K �' CITY ��-f `a4c.�'i
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OCCUPANT�,��P l �4�� OWNER
SOLD BY �'��� u-i �( INSTALLED BY
MAKE L2/iirr c.�a MODEL G Z� �7 3 ��'�
SERIAL NO. � 3� O � � .Z Q � 7 INPUT_ �-�i� d P�%
THERMOSTAT � � x r-S Z VENT SIZE y r
VALVE � �t �-c �\6G a': S TYPE OF LINER ���'��
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LIMIT F��k t � � LINER SIZE
LIMIT SETTING 2 Q ll ` FILTERS: SIZE ��x�S ��C NUMBER �
FAN SETTING �•�-� WIR�NG ��n V�t •S' '�
PILOT TYPE ��t'C'F F s� TEST TAG ✓
IGNITION MODEL C�d� ���'� LIGHTING INST. �/
PILOT TIMING "•�� .S �'�- S
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DATE TESTED �'� � " U �'
PRESSURE 3-� �I C PERCENT COZ � to
INPUT CFH 7 S PERCENT Oz ��v COMPANY TESTING ✓�-3 C !r t�-��•
STACK TEMP. 3 �-S � PERCENT CO � Id NAME OF TESTER N'�-•� ��"`'"`r"�- `�
FORM 235(REV.11/89) FORM DISTRIBUTION: WHITE COPY-JOB FILE YELLOW COPY-CITV