HomeMy WebLinkAbout2016-01293 - gas fireplace ! . . �
CITY OF ORONO * 2 0 1 6 - 0 1 2 9 3 *
2750 KELLEY PARKWAY DATE ISSUED: 10/12/2016
- ORONO,MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 2166 SHADYWOOD RD
PIN : 17-117-23-42-0011
LEGAL DESC : WILEYS PARK LAKE MTKA
: LOT 000 BLOCK 001
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIREPLACE-GAS
VALUATION : $ 4,000.00
NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION.
(2)GAS HEAT-N-GLO FIREPLACES-MODEL#SL-3X
GASLINE DONE BY OTHERS
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 2.00
GLOWING HEARTH AND HOME MAIL-IN FEE 2.00
100 ELDORADO DRIVE
JORDAN,MN 55352 TOTAL 54.00
(952)495-2927 Payment(s)
CHECK 23776 54.00
OWNER
LACROIX,STEPHEN&SUSAN
2166 SHADYWOOD RD
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be perFormed acwrding 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 1 SO days at any time aRer work has commenced.
The applicant is responsible for assuring all required inspections are
requested in wnfortnance with the State Building Code.This permit may be
revoked at any time for due cause.
.
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Applicant Permitee Signature Date Issued B ignature Date
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� Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official.
TS THIS GEOTHERMAL? ❑Yes ❑No
HEATING SYSTEMS
Quantity:
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BT'Us:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H.Power
FIREPLACES ,3✓" ��.� �
1' � ' / ,,
� Gas Factory Fireplace Cp�� Brand Name: �`�'��C�f�
❑ Wood Burning Fireplace
❑ Wood Stove Model No.: ,�X
❑ Wood Stove with Flue/Masonry
VENTILATION
❑ No. Kitchen Exhaust duct recirculating cfin
❑ No. Bath E�chaust(must have duct outside) cfin
❑ No. Other Fans: Locations cfin
FUEL STORAGE (Must be approved by Fire Marsha[I if proposing to abandon tank in place.)
❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑Tnside ❑ Outside
LP Gas: gallons
Other:
GAS LINE ONLY �`( �j�'S
❑ Outdoor Gri!1
❑ Other/List What&Where:
2
t . , +
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00)
—f lJl.t_1 t V 11 x.0125$ .� � �
(contract price) (minimum$50.00)
2. STATE SURCHARGE �� , � �, �
x.0005 $
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
. 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ t
■ * 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 aze 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.
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: � 1 ( Y�
3
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C .��- ��
DATE TIME
CITY OF ORONO cnLLED IN
INSPECTION NS�jTICE scHenuLED _1r���L' -
PERMIT NO. GL�,(,�- --o�z93 COMPLETED
ADDRESS 2 C �c.� r.� S���� ����C' ��
OWNER TELEPHONE NO. ��� y�'�y��,b
CONTRACTOR , C�'����zv�� �� �I
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�� DESCRIPTION •
❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
J ❑ DEMO-SITE ❑ , PTIC INSTALL
? OWNERICOKTRACTOR TO MEET YW YES_NO
� COMMENTS: _
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� O KSATISFACTORY:PROCEED O PROJECT COMPLETE
W ❑CORRECT WORK�PROCEED ❑ISSUE CEFiTIFlCATE OF OCCUPANCY
0 O CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE CdVERINO PERMANENT
�CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pH0T0 TAKEN
INSPECTOR Nllll RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �GTATION ISSUED
❑INSPECTION REW IRED.CALL TO ARRANGE ACCESS.
Csll for the next inspection 24 hours in advanoe. (952) 249-4600
Owr�erlContr'actor on� .
Inspector.T��
WMts CcPYMspector's Fib Canary CopylSib Nodes