HomeMy WebLinkAbout2006-P10118 - a/c PERMIT
CiTY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p1o118
Crystal Bay, Minnesota 55323 Permit Type: Mechanical Permits
(952) 249-4600 Date Issued:
7/19/2006
SITE ADDRESS: 2016 Shadywood Rd unit#
Wayzata,MN 55391
P��� 17-117-23-31-0002
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Pernvt Type: Mechanical Pernuts Pemut Sub-rype(s): Air Condirioning
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00 valuation: $ 1,500.00
State Surcharge Fee: $ 0.75
Misc.Fee: $ 1.50
TOTAL FEE: $ 37.25
APPLICANT: Joel Smith Heating&Air Condirioning Inc OWNER: Mr.&Mrs.Richard Kozicky
4920 173rd Avenue NE 2016 Shadywood Rd
Ham Lake,MN 55304 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 BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE SLJED BY SIGNATURE _�
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
� FOR C[TY USE ONLY
� City of Orono
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P.O.Box 66 Date Received: Permit#
���0�;, , � 2750 Kelley Parkway
��� � �.1 C stal Ba MN 55323 A roved B Amount$:
1 � rY' Y, PP Y�
\ �.��� (952)249-4600
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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 DesiQns—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 modei. �ata shall be presented on form proviaed.
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 Recard must be submitted before final.
TYPE OF PERMIT
(Check All That A 1 )
�esidential ❑ Commercial(Approval Required)
❑ New ❑Additional ❑Repairs �eplace
Job Site/Owner Information:
Site Address: �� � �` �
Owner: � �lL�-- �(;�� �-�- � Mailing Address: � `
�..,
City: Zip:
Home Phone: ' 1�"__.> Alternate Phone: � � j �G.J ��.� �j ��X�� �
Contractor Information:
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Contractor: '���.� �1�1�'�'1�1 ��:����ontact Person: �� � �
Address: ��'I� ��3 r�� ��T Yi' State Bond#: �� ��"��( �� ��f
� _��.;`I
City: ��-�il,I/1�1 �(7.,�.� Zip:�1 Expiration Date: ��' ' � � � �
Phone: ��,���7��(()� �- Alternate Phone: �� � �� C� �Cr �
[� Insurance-Current: �j-��-�;�, -�C� �`j- l���
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MECHANICAL SYSTEMS BEING INSTALLED
HEATING SYSTEMS
Quantity:
Make:
Model:
FueL•
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity: `
Make: �-/1l��-1��1�� ���11I G� M l�I�,i A'���
`J
Model: ,��� ���'�l� '���
Tons: �
H. Power ��'�
FIREPLACES
❑ Gas Factory Fireplace
❑ Wood Burning Fireplace
❑ Wood Stove
❑ Wood Stove With Flue
Brand Name: Model No.:
VENTILATION
❑ No. Kitchen Exhaust duct recirculating cfm
❑ No. Bath Exhaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfm
FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHALL)
❑ 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 - 2002 STATE 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 modification to electrical or gas service.
2. Has a total cost of$500.00 or less;excludinQ 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 $ .50
Mail-In Fee(If Applicable) $ 1.50
Total Permit Fee $
� PEI�VIIT FEE CALCUL�TION(S)—JOBS O JER$�00.00 ���`}(�
If above does not apply; follow guidelines below:
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$35.00)
( �C�,:� X .ol2s �-�,�-�-�-- j�;C;C�'
(contract price) (minimum$35.00)
2. STATE SURCHARGE ** Add the State Bldg Code Div. Surcharge(Minimum Fee of 5.50)
� C����! x .0005 $ � ��
(contract price) (minimum$ .50)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
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 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, thc City may request the submission of a signed copy of the actual contract.
■ **The STATE SURCHARGE is.0005 of the Building Department at(952)249-4600 for the price.
MECHANICAL PERMIT APPLICATION AGREEMENT
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 Signatu�e: Date: � —� � ��
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