HomeMy WebLinkAbout2018-00212 - gas line only ` CITY OF ORONO * 2 0 1 8 - 0 a 2 1 2 *
2750 KELLEY PARKWAY DATE ISSUED: 02/27/2018
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 2695 SHADYWOOD RD
PIN : 21-117-23-24-0056
LEGAL DESC : CHAPMAN ADDN
: LOT 002 BLOCK 001
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : GAS LINE ONLY
VALUATION : $ 1,500.00
NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION.
GASLINE FOR RANGE
1 R/A REPLACE AND 1 S/A REPAIR
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 0.75
PRACTICAL SYSTEMS MAIL-IN FEE 2.00
4342B SHADY OAK RD
HOPKINS,MN 55343 TOTAL 52.75
(952)933-1868 Payment(s)
Minnesota State License#:mech-MB003510 CREDIT CARD 0097 52.75
OWNER
PAULSON,STEPHEN&BOTHAINA
2695 SHADYWOOD RD
EXCELSIOR,MN 55331-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable Ciry approvals,and the
State Building Code. This permit is for only the work described and dces
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 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee ignature Date Issued By ► ature Date
Feb. 27. 2018 12: 18PM PRACTICRL SYSTEMS No, 4125 P. 2
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w �A l City of Orono c��/�'7 /X �l�, ��--
l.wi V P.o.eai 66 ba[c Racivc ��/ `�nut tl O
� 2750 Kelley ParkH�ay `
Crysfel Hay,MN 55323 ApUroved Hy: Amounl S: �.J �r
Phone(952)2�Iq�600 Pax(952)?A911616
���qk�sH�,��.�'� CITY OF ORONO—MECHAI�IICAL PERMYT
(All Commercial peimils mu9r be approved by lhe Building Officisl or 1'nspeclor and/or Eire Mushall)
GEI�RAL]N�'ORMATION
l. You may applp for meehanical pe�mita by mail or in person at ihe City ot�'ices. Applications will
be rerriewed and a�xmiit�rill be isstted witltin nx�o warking days.
2. Pertnit cards will be sent by retum mail after a review is campfeted, PERMITS ARE N'OT
'V'AT.Ib C1N'T�,1C0�1'1tECEY'V'E A P�TtIvffT. VP'O�C biC�ST NOT��Gi1V CINTTL THE
PERMIT CARD IS POSTED,ON THE JOB SITE.
3. Mechanical Desi�ns—Complete calculalions,details and specificatians are required far eaeh
heating,veniilatio,�,humidificaCion-del�wnidificaeion,and air conditioning installation includi�g
l�eat losslheat gain calculation,design temperahues,equipment rating3 3nt�idcnti�iC&ti0n AS t0
type,»>anufacturer and model. Data shall be presenfed on form provided.
4_ Whcn anq nct�v construction or rtn�odtling is invotved,a separate building pennit musl be
obtained.
5. All work n►ust be done in accorda►ice wiQi tlie Uniforn�Mecha�iical Code/State Duilding Codc
requircmenls.
6. All work must be inspected(ro�gli-in and final). Call(952)249-0600.
(24-48 honr notice reqaired)
7. Hausc Hcating Tcst Rccord must bc submiltcd beFort finel.
TYPB O�pERMYT
(Checic All That Apply
�csiticntial ❑Commcrcial(Approval Ctequired) [�ackflow beviee:Q AVB ❑pVB]
1
❑N'ew ❑Additional �tepairs �Replace
7ob Site/Owner Tnformation:
Site Address: e11q�S S�a(�,�O�l n�
Owner: ���Q.l,a� Mailing Address: ae95 S r,od�u,o�d �'d
ciry: �lronc� zi�: -r��33 l
�Tome phone: �.ol.�- �$b � OW Alternate Phone:
ConCractor Inforn�ation:
�lht�Dr1� , A uc.��+►�o� 5
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Contractor: E4�nn �i' '�t�l�rw Contactperson: 2�rnr1t� ��f�
Address: �3h CSOPI'1L�va.An3�S�Ft,� State Bond#: �� Ob.�'rJ I d
City: ��L pti���Q f�G Zi���p�xpiration Y7ate: �//�!��
I'hone: . � „ a1-933�x'1o4 Alternate Phone;
❑ Tnsurance—Cur�-ent: (.PG'S
1 .
� Feb, 27. 2018 12: 18PM PRACTICAL SVSTEMS No. 4125 P, 3
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N'ote:AlI Geotherrnal Systems will now require a Site Plan&Review by our Building Ofticial.
IS TffiS GEOTHERMAL? ❑Yes �Nn
HEATING SYSTEMS
Quantity:
Make:
Model:
�Uel:
�'!ue Si�e:
Input BTC7s:
Output BTCTs:
crM:
COO�.Y1V'C S'YS'C�MS
Quantity;
Makt:
Model:
Tons:
T�.Power
T�Y�PT.ACES
❑ Gas Factory Fireplace Brand Name:
❑ lyood�urning Pireplace
❑ 'Wood Stovt Modcl No_:
❑ Wood Stove witl�Flue/Masonry
VENTILATION
❑ No. TCitcl�en�xhat�st duct recirculating cfn�
❑ No, BaUi Exhaust(must have duct outside) ��
� ❑ No. O�he�Fans: �.ocations cfm
k'[!EL S�'ORAG� (Mr�s�be o�proved 6y!4Y►•e Marshall�f pro�osrng ro aba�rdon ra��k lu place,)
[) InstallaFian ❑ Remaval
�uel Oil: galions ❑ Undcrgraund ❑Inside ❑Outside
LP Gas: gallons
� Odier:
GAS T,YNE ON�.Y
[� Outdoor Grill � Otl�er/List Wl�at 8`c�Vl�ere: `r(l�1�♦- ,
0
2
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Feb. 27. 2418 12: 18PM PRACTICAL SYSTEMS No. 4175 P. 4
_�`�`�`;����� �' - �
l. CONTRACT PRICE s is 1_25%of conlrsct pricc with a(Mfuimum�'ee ai$50.00)
� ����� x.0125$ �d �L�
(conlract price) tminlmum Si0.00)
z. srAz�su�cxaxcE
*l rab0•l�L� X.000s � , ��
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3, POSTAGE&HANDLiiVG(Only on Mail-Iu Applications) $„ 2.00
4. TOTAL p�Rri�1T�EE(Add Lines �-3 Above) S ��',�
■ ' CONTRACT PRICE or JOB COST means tl�c actual or estimatcd dollar amount charged for die
permi�ted work including materials,labor,profil,and olher fixed costs. It is the amounk to be cl�srged
lo die customer for the work done. Tf any marerial,equipment,labor or installations are furnished by the
owner, tenant or any other paity, tl�e reasonable market value of such itcn�s musl be added to tlie
estimated cost or con�ract price for pem�it fee purposes. in 1he eveitt that there is a dispute on lhe amouul
of the job cost, the Ciry may request the submission of a sigtied copy of �he actual contrac�
Tlie undersigned hereby applies to the City for issuance of a Mecl2anical Permit,agrees to do all
work in strict accordance with t�e ardinances of tlie City and the regulaCious of thc State of
Minnesota,and certifies th�t all statements made on tliis applic�tiou are complete,truc and coa•�•ect.
Applicant's Signaeure: ��+�� _ / Date: a��a'� I�(�
,SO �►�l l `�1 �� [�,v1C.� ` 5 �A �'P�.1 r
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