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HomeMy WebLinkAbout1999-011348 - furnace PERMIT CITY OF 4RON0 PERMIT TYPE: 2750 Kelley Par�Cway- P.O. Box 66 ����:tn�_���_.��+� Crystal Bay, Minne� ta 55323 Permit Number: Ff,�� �. �{_, (612) 473-7�57 � Date Issued: ;^��;,��V;:;�=;:=, 4 SITE ADDRESS: ' � - - - - - _ _ ��;{:=;?'��s,�i�l;_ii1� `°i.% - � __ . . . _ . _ . . _ . —�.._—:�.:_` ::i i :_ _ . DESCRIPTION: �=t_:�-;��:.�.��E �. �-t��;� ��yi� _;'�_;E_k��`�: [�;`�•; i , �;_i:i �=s t i� =;.��'� — rt's;:.�_ ��?� li;�;�=i:._ :;��'-, tiFttc:�. E tix:;I�iE j.{4`r#�t�i_ �`t_t a�'��l_E1 j,'_';�.{I_i��l'll'= �_��_i�{-'�.�� �+_ ���i�_:�'? I {��1``;1� _. _ ; t 3t_{[1 REMARKS: FEE SUMMARY: � .,; ;;.2-:..r _ ���-��__. . . � �.� _ _ -. i_i.�ti;;_ F�� �:W'` . .. .. :_:E�1�t �-�,:,���::t:� _______ �• � CONTRACTOR: �— t����s3. i s_�}�-��. — OWNER: `;; �, �';�_ ;:i,(i .'�{ ! ti r L ff.'�i;3 E ;� •,�":sw: �i . e•�t •.! L• . _:_Y.:�.. i i ,L 'i..,' �..�'.1� _L ' 'y'i'•�': ... �: -'iry j.,~ $ I ;.�-( ,rtG= %', ' t'-:.. . . . . Ls+ . _ - - - ---. ,�..�E—. � � i�.:t: _._ .�`! i E}i{_i,f'VI_� �"..� _ .. __ ._.._. 1���!`__.�'s: � _.. i�, �,y_,...... .r-�i i _..t . i.•. —� �"..�`� L. :3�i'`3 �Sa � ��t� � � . . � ��"{� �_����..}��1.we�ir.�!'+��.�..f �'sf-.!—.��'3� �'i�.d�,}�'_+��w� ("��'!�I_ _ _ . . __. » _. _,_ _�iy i t_1 �1-s�.� � #`:� �?z.. :__ �#. .�i_!�d_.,s�k#;g=�#3 •�: i• s r--r ,-t .�• . •.,;._._ L�, ..... n— 1 3 � '!':" :_ . . `r � .a' f _ .. . . I ..������., !E�.� r���€�� ��ar���._ 3"�� �r�_� �►_�,. ��w��.��. ��� .:��-.���� � �w 3��� s�='�I�;�,�� :�f_ i=-� .-_._��_ ._ � ;`�� #���= i t�i������ ;:}�''C3��ii�t�j�.'� �t��'� ;��T _ �E�- ��:,�F3�_����"r� E ,�'_!i�#�"�� ::���C�� �-,i_,�� t. :`� � � ,� ' - � , �- � �� � -�e � �, 1 APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE CITY OF ORONO � 6�22�94616 04/22/99 13:48 � :02/05 N0:837 CI7CY 4F UR()NU �.ICATIUN FOR MECHANICAX.PE�tMI'I' Bo� 66 (x750 Kelley Parkwsy) Cry�tal Bay, MN 55323 ��,INFO$1�lA'I'IOfrJ t. You may apply %ar me�h,aaical po�mics by mail or in persoa at tha City af�iccs. Appl�catfons will bc zcviewed aad a pernalk will bo isauad with� 2 warking d�rs. 2. Pecmdc c4rdx will bC atnt by retam tnail afler � revfqw i' eompleiai. P�RIVIITS AR� NOT VALID UNTIL YOU RFC�IV� A PBRMFT, �VOR��XST NOT' B�GIIV UNTII, T'H� PEYtI��:lT GA1tD 1S PO�TLD Oj��THB JOB SIT�. 3. �e�h�}�ic�j? si¢ns - Co�pl�te calculations, dctnll,s and bpecificatio�s are requircd for�ach heat3ng, veutilatl�o¢,hnraiclification-dehtun'sdlfieatlon, and atr coaditioa9n� inscallation including heac loss/heat gain c�cula�ion,design cemperaeurea,equigrn�ont ra.ing�a�d idcnti�c�sioa ea to type, manufacn�rer and model. Data ahall bc p�a�ntal on form provided. Idcntifiaation of and specitications for water h�ating equipment shell �iso ba prdvidcd. A. When ez�y tiow cquacruation or cemodeling is involved, a �eparate huflding permit m�St be obtained. �. A!1 woric muat be done in accarda�ce with the Uniform Mechanical Cade/9tatc Build�ng Code raqulremcacs, 6. All wark uiusc ba inspccted (rough-in and f�nal). Call 249-460Q. 24-hour notice required. 7. Hou�e Heatfr�g 'Teat �tecord mu9c be 9ubrnitccd bePore ftnal. � Camplete �ll I�eztu on chis epplicatton. Computc d�c perntit fee. �Ign and date the certlC{cation. TNCOM�I,'�T� APPLI�ATIQNS WII..L NUT BE PROCESS�A, lY you have questions, cail 249-46p0. Flease chack onm: �Neev Addldon �Re�a�r �Replacx Rea�d�ntla! Go�rcial J013 S�"x"E: ��l>ti `,�1n�����-x�c�[� �� • �P�...�`�.�`'�..�.._._ Owne7r's Name: 1 j m N�� 1��� Teleph�ne Numbers Maillng Addxess: rn.� , CIty: Zip: Cantractor's Name• � t .g►�- _ Telephdne Numbeir: („1 �l —l�-t C�� Mailin�A�cUess:��l..-. �1 �C',� �. , CftY:�A�'� z�p:. `�y��.I ��Y���EM DF�GR--rprinN HE�,TIIV'O SYSTEMS Quat2tity: __,___��.___ Mak�: �X�,i� ����: c��l_l�f�L����7�,��_ �ual: � �Xue 5ize: � �uput BT�s: CoS?,(7(�C7 � „ . Output I�TCXs: ����� �"�".�". CF�S: __1��1 CQCILYNG S3,'STEMS Quantity: �� Make: � � - .�". Mad�l: - - -- Tons: �"" H. Pawcr .� - -� CiTY OF ORONO � b12?494616 04/22/99 13:48 � :03/05 N0:837 ' �00�,� ' �, Woad Stave wikh flue ______ Wood cornbination or add�on P�ctpry fireplace with flue Facct�ry l�ireplace (s) _..._._... Frcestanding MM�ssoruy VVood Stt�ve (s) Franklin, oCher Arand Nazrie __ _ .�..�,.. Model No. 1bYfg�•'s Min., C�earanc;es, side o rear.�..__, min. �lue dia. .'�.,.T �.�'.��[ No. � ]�itch�n Exhaust _ _ ducted reciraulating �F� Na. Bath �xhaust (must be ducted outside) cfm IVQ. Other ��ns: �...ocations cfrn '�'r�r ��S?�ASE (MUST BE APPROVEp BY F'IRE IVIARSHAL) Installatian Removaf „_;.� �'uel ail: gallana und�rground inside putside i1P l3as: _._� gallo�s 6�ther Gas opcning � l�t I. 1.25°,� vf��t,�' i e* or ����g��� - - � ���.v� x .Q125 $ ���,,�,� ^ (Cacuracc price) . �� �,.�,�1},1�"g�;, ** Adci the Stace $uilding Ccde Division Surch,ar$e to each permit. l ` ;���C'� x .0045 $ ,�_ car �.50, W�iC�l�v�l' iS �i'Cate� (contract pCice) 3• �'ast�ge and Han �ina (Only anail-in applicatfon�) $ �,�Q 4, '�"OTA� PERMIT F�� (Add lines 1-� above) $ :-.�_?,��, * CpN'iRACT PRIC�or JC78 COST�ncRn.a che actaai or escimaced dollar amounc ohargo<I for the p�ermitced work including �naterials, Eabor, profit, and ott�er fszed coats. It is the amouat tp be chargcd to the cu:stomer far the work donc. 1f any matezial, equipa�er�t, labor, ur ins�allacion arc furnished by the owner, ucxant or�ny otber party the reasonable market valu� of euch iten�s muyt be added lo ihe estimated cast or cc�nCrxcl prica far permit iee purpc,ses. in t�C e+vGnt thut thcre is�dlspute on thc �ntpunt of the jab co4t, the City may request ehe submission of a aigned copy nf the actual contract. "'" The STA'C� SURCHARG� is .0005 of the coatract prfce undec $1,OOp,000 or 5.50 - whichaver is greatcr. Far valua[iens over $t.Q00,00p calI tha Deparcment of Inspectfonal Scrviccs Por the pricc. The unders�gn�d hereby applies t� the City for issuance nf a Mecharlical permit, agr�es to d�:� all work in strict accc�rdartce with che ordinar�ces of ttte City and Che regulations of che Minnesota SCate Buildirtg Code, and certifies that all siatements made an this xpplication are complete, true ,and correct. Applicant's Signalure: �� �.� g �____^ Date: -�`� -_� � � A�pr�ved k�y: �� w ..�,.....�,.�........._.�...,1_ Date: CiTY OF ORONO � 6122494616 04/22l99 13:48 � :05/05 N0:837 $eC.!3.04�lGHTS[)F SIJBJ£CTS OF Dr�TA Subd. 1. T'ype oP data. 'I"ha riRhts of individurl on wh�m th�dap is store�!or co be stored a1wU bc aa aot fvnla in thi�socdon. Subd.2. Inf�rm�tion r�tdred to be�rcn(polviduad• AA Indiv3ducl�isked to supply privata or confSdenCal Qap coecarnirig hlmself shall be l�tfotmed of� (r)the purpose dnd intended use of che rcquescrQ data wi�hin the coUec�ing Sata egency,pokitlC�tl dubd[visinA,or s[atawida eyaKm; (b)whechan c�may rcPlue or i�lap,rGy�¢qulred to supply fha requeamd dafa:(c)enY Irnown conseq�ience a�i�In,g tYnm hie yuPPlyia�er re}Uaiay to s�ipP�Y ptivAua or confidautiel dacq;and(d)t6e idencitY of other p�raons or entides authorizad Dy ahte o�fede�allaw ro receive the data. 'Ibis requ�remeni atall ttoc 4pplY when An individual is dsked r,o auppiy invezrsgadve Qaru,purn,ant�o secGon 13•B2, subcti�iaioa 1,co a!sw enforcement oltfcet. '�71a GQO�RVA61q0�[,�p��v�nu�ma�ylacC i C R ��g��jrc� und r�,6 su4dir�sion in��e indfvjdyq�_jqcom4 nx or proD{�tv tax rcftind + � � ons,��a4 410�1�4.AQ.L?�� Subd,3, Acces�to dqta by indlrldu�l. Upon roquese w a respanaiQlr eutharuy,an individuat shall be ia[otmed wAelher ho itl che aubjpct 0�iW[Od CIBf�Atl L'1QIYICU11I6,an�f wtiether it is classllfeQ as public,privau or confidential. Upan his N�rthar rcqueu,An indivl4uat who is thc subjeet o(9tored povqte or pnblic detd o11 tttdiviQuala sha11 ba shown the d�ta wid�ont any cheltge to him atk1;if he daircs, shall bo inPorrned ot the oontant qttd m�anuig of d►at dBW. APoCr an individual has been shown thc private data en6 infecmad of Its maoning,the data necd�ot be dlxdo9cd to h�m for !iz moptha dxr�afwr uNc�9 8 diapute or aadon porsunnt to thix sacrion 4s p�ndtng or xdditiartal dar�on the ir+cliv{dunl hRs been colloctbd or erentad. Tha teSpaqsiblo aurhorlry sbmll pro�ida cOpies of the p»vac�4r publie datY upon roquese by rhe individual subfect of tAe darn. "1'he ralponalble authoriry msy zrqui�a th4 requas�nQ ponon ro pay eh�acwal costs of makulp Ceztifying,end compilin�the copiea, The rosponsibla authorrry �hall epmply immediakly,]f poasihle,With a�y request m�de pursuAni to this subdivision,or within fi�e dpy�of tha datA of the raqueze,nzClu4ing Saturdsys,Sundays and la�al Melltlays,ff immedlote aompiianca is not possihle. Ilhe cannot comply wish the request within dfst tkroe,he shell x�mfarm rhe lrxfividusl,ar�f may hsve xn add'ttional fiYe days within which ro comply with ttlo nsqurEt,exCludllfg Satunlays, &uhdaya and lo`ai holidays. �tzd.4. Prar�edure whe�dats fa not accurata ar Comptele. An individua!may contcst tEto accutAey or eompleDene�s o(publte or privaca Q�ta cat�tarstin�himsalf. 7o axeraise U�is n�bc,an indiv�qu�shall eorify in wridn;rhe nxponsible authority describiog die�aars eP the disagnemea�. The respnnsibla auchorlry ehall wiitrin 3A days ei�her; (a}corrsct the dera tound to bc faxcwr�te or incamplem and attempt to nodfy past recipienu af iaqccurnce or incomplou dxfa, includin�recipiencs npmed by�he indivi�ii�el:or(D)noufy ehe inAividual ehat he txlleves�he dete ro be cortec�. Daw In dispub stwll bc disclosed oNy if thc indiviQuaJ's statemen�of diAagreement is included�vith nc�disct�rsed 6aw. TTte drterm{n8Z1ua of�3fe respanaibie auth�eiry rru�y be sppented purausnt tv tha provisions of thc admit�srroCve prncaduro acc relo�ing m cont�stad crses. nA�TP�Y��Y�n 4R� in accardaz�ce with M.S. 13.Q4,Subd.2, "Righ�s of subjeccs of data", wc would like co inform ynu chac your rcquest �ar a permit or licec�se frnm che City of Orano or an� of its depercmenes may re�uire you to furnish certain private or cnn�dential imformati0n� You are notif'tcd ihat: 1. Tho inforYnatinn you Purnish wi11 b�used to determi.ne your qualiticAtion for�he permit or l9cense requcsced. 2. You may rcfuse to supply data, b�t refusat may xtquire that the City deny the permit or licr_nse. 3. 'I'he informatiott may Fae shxted with oChrr loc�l, s!ate or federal �geneies to the aztent neces.sary ro process tha pcttnit or ticense. 4. If your zequestad permit or license rcqufres Courac;l accion co apprave, some informatinn may becorne nuhlic. 5, You have cercain righcs ur.der M.S. 13.�4 (av�ilable upon requesc) to review private Qata au yourself. �. Your ful.l name is raquired to process this applfcation or petxnit. `���v.�� t- �R�h� „'��� Firsi Middle La9t �.,�...:. 1J(7 1 Yl_aCl�_���rl��a_� . A(J�rB .. _ s-Y'�(`�1..1.f,-t/ "1��. Ciry �' ' — snte Zip Phano � T undeFstand my rights as xcaced above. ..��r-�_.W_.__._�� . � Sisnaacro FAX COVER SHEET DAVE'S APPLIANCE HEATING 8 A/R/NC 1601 37TH AVE NE COLUMBIA HEIGHTS, MN. 55421 612-781-6901 612-789-8605 FAX SEND TO CITY OF ORONO From Attention Date INSPECTOR Office location Of�ice/ocation BOX 66-2750 KELLEY PKWY i Fax number Phorte number 612-249-4616 � Urgent X❑ Reply ASAP � Please comment � P/ease review � For your information Tota/pages,including cover.• 5 COMMENTS ............... .....- � ... ...... � ..... ........ ........................ - .....---- CUSTOMER HAS NO HEAT&WE WOULD LIKE TO INSTALL FRIDAY APRIL 23, 1999. ----- --- �-�-�------------- - --------- --------�-� �---------- ------------ �-�------ ---------------------�-- PLEASE LET US KNOW ASAP IF THIS CAN BE APPROVED OR NOT. ..---..... --�-�----••................................................................................................. THANK-YOU. ............ . ...-� -------- - .....---- � ... � - -................... - - � �--... --�-------�- � �--.... ...... � �--�-� � ..... .... � .....--�-- ..... ...... . . ........ ........- - ....-�--- � .. PLEASE CALL ELLEN OR GRETCHEN ASAP-612-781-6901 ............................ ..........................................--�-------.......---�- -..................... ---�-- --....-�. ............................... ........... ..........................•-�--....-•--•------......... --- ------�-------- .............................. ...... ........ .....----..._.......-------........ - ---------------------------------------•-•------•--•-•-------------------•---------•---------------------------------- ------------------------------ -------------•----.....----------�-�-�-----�-- - --�-------- -��--------------......... ......... �----�-�-----�-�--•--------�-•-••............................................................................. ...--� .. ........ ................... . �-•---------•--------------�-------------��--�- --------� �- ------------ . ..............� - �----� --�- .... � ...---�� ....... -� --��-�----- - �--�----� ....----�� .......................................................................................... � �--�--........-�----...... .--�-��--�- .....-- � ....... ......... �--�--------�-�-------��-•---•...................�---•-�----------- - .... --------�- ------ ---- ----- - --------- ----------�- - ._.... -- ....... � - ....... �------------...---.. --------- ------- ---�---�--------.......--- -�-----�- � -- ......- - ...........-- �-�--... -- .........- -- ... ..............................� ......- ................. - - � �---------------��--------- ._...--�-----��-- ...-�-�...........................�---.....-�-----•-••--�-�--�--------��----------•------------� ��-----------� •---- �------ ��------------------------------ --- �----�� �-------�- �- ��-�---....- �-�------•- -.....---�---�- ...---- .. . ................�- -............----....-�-•-------.........-----....-----.......---.....---�-�-----•-••---....... � - - ._ - - ....-�- - .......-—- ...... —� - - ----- �---------�-— � ---------— ... .. . F F.-�- '�i THi� I - FP�f I.�,�.��'E' �� AF'F'l I.�r���:E F:`�: P��I�:��. E I � `�'�,��) ��,�ij�� P. �'� , �'1 I� oF olio�o u � 6�22494616 04/22/99 'I3:48 � .02/OS N0:837 . � f f ��''j�'�� �5 C:T'Y'Y OF ORQNt� A�,ICA'�'x�N�'4R M�G7�.A�CA�..P�RM�'T Sax 6f► t�'750 KeUvy �wtxwsy) Crya�tal Bay, MN ��323 1. You �1�1y dppIy fot tuech�ic+l permits by mait nr In persoa a� the City offi�ta. AppHcations will be tcv�twr.d add s�erpiilt will b�e tssuGd with� 3 woridng days. �. Peraa�lt c4rd� wt�l be ecnc by re[�Lm mail afler a rtv�vr ie complece�, pFR1141Ts ARR NOT VALCD UNTKL Yql7 REC�iV� A P�RMIT, ��(5,T NOT 8EQ4N UN7�'CHH pE�LMIT CARD 1S P�O,�'f�D ON TNS JO�„�, 3. M�qhig��Lp.�jgdg - Cotn�izte salculatlons. dscsila snd Rpecif:coilofis are r��uired �or ca�h hc•tirg, , veatilatlo4,htlmidiYic�t[ot!-debt�dil9e,�tiun, aad alr condltloqixxg ln��allation �cludiag heat loaslhe8l gaiu c�,culAtioa,�e�igi1 LCRapel'aCu[ts,cquipment ra!(J�1�1d ider►ti�caxion ea to ty�ze, masufAcRtrtr $ad model_ Aalx aihell be gt+C.fprsted on fosm ptovidtd. Edenl.i�Sc�t.ion of�d�ecilfcatlou� for water heati�g equiprzient . st�sll also bo.prprided. 4. Whep �y new caAeesuctio�n ar retnodellt►� ix iavoiv�d, a sepa�ate bn;1d't.ng �crrult xn.�st ba absninsd. �. All waric tnuat bG done un accvrdestiee wlth the lf'nlform Mcchnnfc�l Code/9�eto Suildi�lg Code requtrem�e�ac�, 6. All wprlc�►wt bo itlapeceed (rou�bwin and finn]). Cail 249-abb0. 2R-heur not�ce requirtd. 7. Hou�e HGatl,ng Test Ettcard muat be aubanitted befarn fFn�l. � Cosn�lae ell lcema oo ehi3 applicatlon, Compute tbe per�it iEe. S[gn rtud d�te i�a ce�tlfitmtian. iNCUR'SP��`s"f'� APPLiCATIONS WIl„1.NO'�' g�PRbCP.SSLl7, 14 you hava questions, call Zd9-A60p. Pltase ct�aek arae: N�+v �_A4dit3at� Ro�sur �Rtpiaoc R�9dqitial Cvrsur�ErCial . JU� ST�t'E:���`=�....�'��l. �y (� �'�.. - - ��_�..`��...�.�.. owner's N�r�te: ��nn N��1���� '��l�pbon� Nut�nbers __ N�fl�g�,dd�'e�: ,� Cfty; __ Zipi .�.�._�.._.Y �.onir�ctQr's Name: � � ��+� Telepho�e Na�utb�rc (�1�!►$l �ld�'-t(�1 Mllili�� Add;'esst 1 t n �� �i 1 �f�'_r - ____.._���}''� ` ��1��..��.� -�._.__ �Y�T�M D�S�iON �F,A,'I'IiNa SY�TEMS Q�a�siry: ,-.-.��—._ - � � Make; -- 1+rtodel: ��' ���NO(�D�.._...._ — �—. � b ���� �+tuc S3�e: _.�..`�.�,... ` - - —�.� � - -- �t�ut H�'�3s; �....�...... __ ��- �5�����?o ......_....,..�, _. ouc��t Br�rs: �s�.nau__ �. -- - -- CF�M: �� - - - - --- -- -- — copLTNo s�s��Nrs C2uantity: `._. __..... _ � r _ ...-_. Maka: ...��_.-._.�.- �..� _-- � � Model: 7'ons: ��._--_ ...._ --- � �.� _..._._�-- kI, Powcr r�r_-� �,i`=i T�H�� 1 -�_ F'1�i I���."E�` _ .�,F'F'I,I: ���I�'_�� �.... . _, :�1 .. _ ! �_E_�i=i�� P, 4 . LLlY-�r uKu��y � ��' 612�49461b 04I22/�9 13:48 � :03/05 N4:8�� w(��,BURx�rr(;�F.n1FT��� ,�.�, WoOd �tove w ith fluc � Wood cornbination or add-an �, Pactory fir�p1ace with t�ue ,�� k'actary Fireplacz (s) �..� Freestanding Maso�try Wood SWve (s) Franklin, oth�r Hrand NRme --- -.��... MadG1 No. J Mfg�''s Mit�,. Gie&rAm;es. sJrl� .�, re�rf,�� nlin. ftue c3ia� . ,�T ��� �I+a. � Kitchen Exhauat _ duct�d recxrculatir� �_____ c�m I�o. � Bath Hx.haust (must be ductEri autSiQC) Cf'[r1 1*to. _-..` �th�r F�ns: �.,c�atiuns __� �^� � Cfm �'L�?,.,,c.,�'��� (a►QUST �3; AP�'ROVEI] BY FIR� ;MAR,SNAL) __� Inst�ltation �, Rernoval _,,, Puel 09l:� gellons undergro�lncl _ insid� ourside �_ _ ,_ �P f�as: ---�_ _ Sallons �--- _-:_.� Qthcr C�s o�ni�]g �e�i`����,.�I�4'�'iC7K 1_ 1.2.5°�, of�X i e* c3r QQ� x- - ��?�€;.u � x .Oy 2g $ __�,���%���- �'`� {Garur�t.ps�ccj 2. ,�I�.t�L��y *'" Add thC ,5tate Br��ldl'ng Cix]e T]it-isinn Surcher�� ta eaci� permit. �1�'_�:�,.(� x .ppp� � , ���`, <�„� t�r �,�0, WhiCh�vCr is greSteC (contrect pt�c�} �� ' „� (dnly rr�ail-in appliratfons) � _ ��d �l, 'I'�I'AL �'�R.�vI1T FF'.�, (Ad� lines 1-3 ahave) $ .- ---_-�,,� ; � �` CON�A�T PRlC�.o�r JL1B C4S�'tntAt�.v thd e�tual �estimated d«llax' amqunt chdt�ed for the permittecl wo�k inriuc�ing ros�erla�s, tabor, profi�, �nd nthar fixed fi4stS. It is thC nmount �v be ChAi'gA� to the �u9tOtntr far t,�tC work dot�. 1f any rna�u�ial,equigtncnt, ta�r, vr�ns�a]tarion are futri�shed by ihc awnrr. tcnant pe any othcr paKy ►hc reasanablc rnarket valuc of auoh itet��s m❑vt }>e sdd�d to the csllm�ted cnst �r c�ntract price fas permit Fee pury�c+ses. In �rc cvcnl �ac ��ere is a dlsputc on thc amount nf t}�G job�ost, cttie city muy raqvest tho auhmission of a sigttcd c�py aC�c actusl con�racc. '"'" TIYe STAT�; 5URCHARO� is .p045 of the contracr prfce under 51,000.0(►0 c.r S,S() .. whichav�r is grcarer. �or valuaiions over 31,UOO,Opp c�l! th� 17eparttntnt of Invpec.�lon�l Serv�Ccs for th� prirc. '�'1�c undersi�ned r►er�by applies ccs �t�c Gity for issuancc of a Mechanical Permit, agr�es to iic� AI1 WOi'EC in strict �r�orciance wich �e orditiaraces uf t1;e �i[y atK4 the regulations of the Minne��ta SCaiG �3uildir�g Cpde, �nd certifies that atl statetnents snadc an this appli�atian are Gc�mpleCe, trtae snd cc►rrect. A�iplit�tit'� �iqt�ture: ------ l�atc: - ��? Ap�inved i3y: .,.........._... ' _ .�.�._.v.--------..�..;._._..,�. -��., ��ke: � � �-1 .,F F. --i`=i T�Hi! 1 � �:� F'l��i I��.k rrE' ; ,�F"F'L I:�i��I�."E F.��,;�: Id+='�, �;� �;�,��i �;�;il r� F�, �� � �ti i r "u� �Ku�� '�' b12249461b 04/�2/99 13:48 � :OS/05 N0:837 aea��.as nrcH'f3��su�crs a�nA�rw Sut�d. j. �'Y�O(d�h. �'}�tl T1�IItd Q�ilfd'lVldyil oti Wb0{!1 m6 Qa.(a ts�tDiD�i pf to D�s4ored ehqll ba As wt fvitlA IJA 1hi1 6CC�iCn. SuW.�, 1n[oc�nulou rcq�ed t4 be�r�ra�,�viqu�J• A.q t�dfvlduel rtstc.d w supp�y privi�a ar ov�dentlal Aacx ca�carnin�bGusel!�ha�1 e�Fasfenned of: {a)we purp�se er�4 lntandai uae of uF.srquesscd Caa�wtshin tlde�nUrcw+g 6uta e�arwy,palldc�l�Ubdi�isien,or�utawlde ryercm; (b}wf�eil�rr?,e m�y�cl4+r ur i�1aA�llr.equkred so supply U�n,cque�xai Cota:(Cl isy knowr�contequtn�e�rlxkng tr.rm hi��upplyln6 nr reN�[np to s�iPP�Y p�i��to or wnC��faaoe!daw;a�,a(Q)me idenaiqr ot a�her persoaa ar eaades authotuan Ry sta te or fcder�!law�o receive trie dan. 'tltil9 r�qul�tment eeall not�pp1y�uha��n�ndivipual{i�,pked rp wpply�nveSr}gadva d,Q.puRut�tt ttl st�Aoo t3.82, 9UDC1IVIflQA a.fq t I�W pn(9TC0�10RS O�ACtf j$g cumm��Honer o[,�vy�e a�y�+l ct.Iht[�s�j�}�Irt�{ �hdOt.�s _ , ! t ion���tiie ineJ�tdukl_la4A"14 nx �r p%���a.s rewnd I�liiYlCf�Of13 ln�(j,�Ql1�P�9[o ,tRtiS. Subfl, 3, Aeesr Yo A�tn by Indl.idurf. Vpon rayy�st to■nepvnt�ata wA,aruy,rn{ndi�idu•l sUa[F be 5alorme4 wReM�er rn Re d�6��hjea of ituroQ�dc�on iodSvislqtlr,uu}whQ�Aer ic ic rlASSlAra 9s public,p;;vAu or caaACenria�. Upon hts N�rr requcu,�n irallvidual who[6 d�e subjec� u1�w�+ad prfv�to or public dpta on ltW�vtQutl,��doll ba.slwwn�ha d'xta w''tlliout Any cbllt�e to him�u1e1;ll rte do�irsf, shall bo fnformsd at tr�e con�aa� 4�fd 1'n�aain;of tMe data. Afl�r u�inAivi�ival hai bea��shown ihs privrte eaw an6 fn�0emdd of i�a ox�anin;,d,a dasa nc�ed rtot�e dlsc•�oeed w kiro Co. �Ix mopths there�flar ardc+el�dupp�e or.cuoo por�unnt to 1Ai�sccho�py pending or ad$itronxl dat�Qn the�Qi+r;du.l h��beee eallat�d or ertnmd, T't�+toFpaiuiAta�u�hqrfry op�li provido copk.of tfia pn�aw or puDli�dpa u�+an royuosr Ny the lndividual iubfoct oftho cfAta, 'I'he raspa�wdbla ou�orlry MsY�'�'OuVr�t tht«�ryestin`penon�n pty�he acrosl cou+of makin�,certifyiry{,und cocnpiling�he coyiea. 'Y?�e r.a�vnsibta suthoriry she11 cpmrly irnmediII�ty,li pouiDle..with apy rrquest rnrde pun�uant{o tl1i�tuba{vision,or wi�hfn tive dpys af � [h�dif�oPlhe raqu�rt,axr.ludfag Satvrdsys,SumSaye xnd le�a7 lneflday�,ff immadln�e anmpllance ie noc pos�ibfe. 1lde cae�n,at comply wtth tha re�uadt wi�u�d►�t dme,bn ahell a�h�form ihe lndivtdual,arld n,ay hivs xn��dicionAl Cve�ays w;�Rin which eo compfy with tMo mquas�,e��iuding San�Naye, Sund�Y��nd Ioi.1 hotfdAya. &n�d.d_ prac�dure whep da.tr!�not accurnte or eemgt.�e. An individual m�y canusr Ute securacy or cnmrleteness o[publ[a or�+rivare a•uc ca,rcerntnR hin,elf. 70�xareise n�h riRhc.�n inui��n�v sna;l nonry in wncsn;u�..e�nsib�c nun�u�ry doscrlbing d+�n4wre of Eto disa�rcomen�. 'Y'h�ra�wn�tbla wtlto�ry xhall u�i►hin 3�1 daY c etchet; (a)cortect tTie daw fnu�scl te be iartcur�te c+r iocompleu�nd urempt w nudfy pees reciDients ef 1nA�4r'aUf oP 111coinplata d�li, inclvdins rcolPir,ncs nAmed by�he ied[visival;or(h)nodfy�e indlvldnel��t ha btlSeves the d4ta to be correc[, DQ�n In di�puro shAll bo di�clasee onry il�e indtvi��l'f�tx�emen�o(die��etetrt�nt i�Intluded wifh the Oisclosed deu. 12ie d6tE]'m�t111btt of the T¢spvn8ibk�u�hariey mry De eppsaied pursu�rir w the provixions of rhe adm4ilcaative�ruce0ure a«rr-farin�tn carlltsOCd cll;pa• . �?t��p -�'-..l�;�Y Ai�YTSbRY ' la ao�otdance with M.S. 13.a•�,Suhd.2, "Rights of subjeccs of dnca", we would Ilke co irtPorm you that yqur request £or a permlt or IScense frum ►fia Cicy of Urono at any af its deparcmen.�s may require you tu fur�lsh ce�tain privata or cnnl"idential infarxrlq[.ip�. You Rra no�iP'ied that: i. The lnformation you furnlyh will bc used to detcrmina your queliflcation for the permii or Iicrr►�a requested, 2. Yau mar reSise ep supply dac�, hut rsfusal may rcquire ihac lhe City deny �hc perrnit or]icense. 3. '(�te infuCmq,tion ttiqy AC.shared wfch oChc[2oCpl, s�a.�e or fcdcra! a��ncies co the Gx�e•nt ne�tssary �n pr�cess �hc yctmi�or ticensc, �, iY yaur xequesttd pertuit or licensa xtqultes C:ounctl acrion ►o �pprovc, some infarmation may become publ9c. 5. You hav� ttrt�i�1 tights unr.l�i M.S. 13.04 (availitble upon re�uesi) tu revicw privAte dnta O�yoursetf. 6. Yo�r ful.t name is rcq��ir�d to�roc.ss this a�pifc�i�on or permii. � ' ._., _.�.. �--� - - �R���.,�� - .,. _ .____� , F1r�t Mtddle Lnec �.��-...__.:��aC�.-�- .��—._. Ad��ra , �-Y`1t���-��! -- �n'�'�.�.�����,.�����"�.�—���c�. Clry � Stara Zip PhOn4 � I understrntd my �igbts Qs �tated abovo. �..�'�--�----� _ ��;��._, ___ s�anaa�r� ,F F:-',:;_��'=� �''H i f l �';�; F'PP1 I��.�4'E' ;, �F'F'I:I.�1'��:E F.�:���: P�I i=;�, F�l;; ��=�'� ��h f j r� F, -, , �11�',0� okON4 � 6122494616 04/z2/99 13:48 � :Q4/0� No:837 C����t'�'IA�. C�}�tTIFXCA'1`Y[)ly APPLICA�'X'ION Ci'1`Y O�' UltONO 2'�90 K�IIy P��rkway, P.O. Bo�c �b Cr��ta1.Hay, N1N 553�3 Fhot�ee Zd�-�Op su�'rness�- � p��,�. �::: ��_�L�_o��.�. �lddre�s� � TN � t�:�xss�,e xomc) ---��_�.�1__...,_..,_. _.Ft�.L.`._-�...�._.� _..--,� ,�-- ._... e�cy:�L����..�.� �,., sc�t�:. �,r� � � ����'��...�. '�`y�e pf Li�ertsa NCI�; Master Pl�mber ��c�uS� MoVer_ .. pt��� Stat� �,icense Na. Fs�cpirarlanDnte� diava you cvcr had a [icense revuked?,�,�Q 1�yheri �_� �T}�. n � �T N4TE; The City dces npt hav� a �peci�+l bcsrjd fnin� to usr. P�r<bf pF V4'orkerB Campens�tion insurt�ncp covCrag� i� requirecf for a!1 contractors. Check l�ind af trade ap�lyl� fpr: ��, 5ept�t �Q.htraCtAr (Requireci; �MPCA Individual .5ewag� Treatrnenc Systems �.icen.r.e) „�,�„�^,,.�.._ �iouse Mover (Roquircd: $2,O�Q0 Bond, Ip-3U-104,040 Insurance) � MeChat�tral (�t.�quircd: $�,OOQ Hur�d� 1U�50-IOQ,00(1 .f.ns��rance) ._..�_..�. �_ kit�r��►er (£�e-yuir�B: $2,000 8omf, f 0-SA�100.00Q XnSUrance (]R a capy vf tlte State Plumbing in�su��n�e/Bonc�} Municip�l connections (sewer/wat�r) Yes Nu � �_ T.._.,.. Flre $pr1�#cl�r �hstall�r8 (�equincd: $2,00C) Bp�d,. ,10-•5Q-1Q0�000} 7UVork shail not cot�rnencc unt;� shas ap�licati��n has be�n appruved and �CCquirrd pemuts are issued. Pl�ase imiicate any other perspns auth�rized by yc�u �o apply for permits: Tho ut�de�raigped hcreby makts application to the Cit� of Qrar►o, Miru�sota, for crcdendal csrctt�car.ion aa indicAc,�d aUrsve, Sub,�c*�;t to [h� l�us of the S�ate of Mlnne.saca �nci tho �rdinaiices , �f cha Ciey of qrot�p, Al! appJicat'sons are subj�ct to a te�x {10} day appror�al perio�l, If disapproved, writtcn noticc w�IX h� sent. Sigt,atur�: � U��: .,F'F:—:...—`:i��i fiHii 1 ; �1 F'rr� I,�.:�:�EJ ,, ";F'PL [,�P�d��'�E Fu:�: P�I��:��. i:�1.:' "�:�j �:�Fij5 F, 1 �AX COVER SHEET DA VE'S APPLIANGE NLATJNC3 8 A!i?1NC 1 d0i 377'M AV�N� Cpl�UM,BIA HEIGH7S, MN 5542t 612-i$1-6901 6J2-789-8645 FA?C SEND TO � C1TV OF ORbNO From Affenlior� -=i-- D9f9 —_ lN P�C�TUft �------...__ . --- OfRCe lOceflon OfFice Iocstion BOX 66-2750 KELL�Y PKWY FAY n�1m�r PhG±ri6 nvMt�er 612-248-4616 _ . � UIg9�f � Rep1yASAP � Pf@8Se Comr»ent � Pleasg rov/ew � For yiourinfdrrtietion Tote!pages,lncludrng cover:� 5 COIYIM�'N7S . ........ . . . ..............�-�-�--...............,.,,...-�--� - - - ---...-�-�------....._:.. .. . . .. . -��-- - --� _._CUSTOM�R HAS,NO,HEAT.&WE_WOULD_LIKE TO IN.STALL.�RIDAY,APRiL 23, 1999._ . ---- -�-�--——-— —---- PLEAS�LET��S KNOW ASAP 1F THIS�AN BE APPROVEC��R NO7. ,,,,,, ................................................................................................................. . THANK-YOU. ..................... ....... ..................,......,,a.,...:.........,....-----...............--—--.....,..... f�L�ASE GALL ELl£N OR GfiETCHEN ASAP-812-781-690i �.......................................................------ --.........................--•----..........---�-��---... .... ..,...-�-�.................. .................�-�--....---......- ---- - ---.......................,....__...- -- - .... -- ........---- .....................................................................................