HomeMy WebLinkAbout2012-00909 - mechanical , CITY OF ORONO * 2 0 1 2 - 0 0 9 0 9 *
�. 2750 KELLEY PARKWAY DATE ISSUED: 09/1U2012
ORONO, MN 55356-
(952) 249-4600 FAX: (952)249-4616
ADDRESS : 2760 SHADYWOOD RD
PIN : 21-117-23-24-0040
LEGAL DESC : REG.LAND SURVEY NO. 1196
: LOT 000 BLOCK 000
PERMIT TYPE : MECHAMCAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL-MULTIPLE
VALUATION : $ 22,000.00
NOTE: 1 BRYANT NAT GAS FURNACE
1 BRYANT 2 TON AC
APPLICANT MECHANICAL 275.00
METRO AIR INC. STATE SURCHARGE MECH(VALUATION) 11.00
16980 WELCOME AVE SE
PRIOR LAKE,MN 55372 MAIL-IN FEE 2.00
(952)447-8124 TOTAL 288.00
OWNER
ENGLER,JEFF
3330 MARTHA LANE
MINNETONKA,MN 55345-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according 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 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.
yYK�� / / / /
Apphcant Permitee Signature Date Issued By ature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
FOR CITY USE ONLY
,�` City of Orono
O¢O`rO; P.O.Box 66 Date Received: Permit#
2750 Kelley Parkway
� ��' �„ � Crystai Bay,MN 55323 Approved By: Amount$:
�� ����ry:,�a��/;� Phone(952)249-4600 Fax(952)249-4616
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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 UNT[L YOU RECENE A PERMIT. WORK MUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical Desi�ns—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 model. Data shall be presented on form 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(952)249-4600.
(24-48 hour notice required)
7. House Heating Test Record must be submitted before final.
TYPE OF PERMIT
(Check All That A 1 )
�C]Residential ❑ Commeroial(Approval Required)
❑ New ❑Additional ❑Repairs ❑ Replace
Job Site/Owner Information:
Site Address: �� �' � y � ��� �� � ��
Own • � � ' C i'"' Mailing Address: ��1��0 ��u� G��►'u»��p
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City:�kTr�, S 1 l��' Zip: � -� S � �
Home Phone��o� - �V�(-�0 7�a Alternate Phone:
Contractor Information:
Q� , - � � � �
Contractor: ���Y�C, 1\1 ��►�� Contact Person: i h t y l �I�,I �,
���; s� �; ��( ��«,:�,� r� (,,� 5 l��1 �
Address: \ State Bond#: `; � �
1 � )
City: � �' �''1��I� Zip�3� Expiration Date: � � � �" � y
Phone: �� � �''��1.��a� Alternate Phone: �I��a'�H7'� i��0
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Insurance—Current: �h� I' �— � �
1
MECHANICAL SYSTEMS BEING INSTALLED
Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS THIS GEOTHERMAL? ❑ Yes ❑No
HEATING SYSTEMS
Quantity: �
Make: �r y'-�*���
�7 r
Model: � � 0�������J
FueL �' k�
•�iiQ�`
Flue Size:
Input BTUs: �}�UV
Output BTUs: � 1���
CFM: � S �S
COOLING SYSTEMS
Quantity: �
Make: �%-�)C,-� l
Model: � �� 1,>+U� t��•�
Tons: �
H. Power
FIREPLACES
❑ Gas Factory Fireplace Brand Name:
❑ Wood Burning Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Masonry
VENTILATION
❑ No. Kitchen Exhaust duct recirculating cfin
❑ No. _� Bath Exhaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfm
F`UEL STORAC E (Must be approved by Fire Marshal[iJproposing to abandon tank in place.)
❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑ Inside ❑Outside
LP Gas: gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill ❑ Other/List What& Where:
2
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;excludin�the cost of the fixture or appliance: and
3. Is improved,installed or replaced by the homeowner or licensed contractor.
Skip ne�ct section,if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $
PERMIT FEE CALCULATION S -JOBS OVER $500.00
If above does not apply;follow guidelines below:
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00)
�� � �?
t��, l'� � x.0125$ .�� ,�
(contract price) (roinimum$50.00)
2. STATE SURCHARGE �� '�� Y'j �I �
x.0005 $
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
� 0 �� ��
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, the City may request the submission of a signed copy of the actual contract.
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 Signature���' '- L - � Date:� ���'� �
Reset Form
3
C � i>� DATE TIME ✓/
CITY OF ORONO CALLED IN /O� v
INSPECTION NOTICE /� SCHEDULED !D/�-/2 �drj
PERMIT NCI�>3=�`�� COMPLETED
ADDRESS �7 � �`"�-� �� ��--
OWNER ELEP ONE NO. ��� �7�g�ZT
CONTRACTOR U
� DESCRIPTION �� � -�" `�"
� ❑ FOOTING ❑ PLUMBING AL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTI FINAL ❑ FOUNDATIOWREMOVAL
� OW NTRACTOR ET YOU:�YES_NO
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W/y�WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
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0 ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (952) 249-460�
OwnerlContractor on site: ''
Inspector.
White Copyllnspecto�'s File Canary CopylSite Notice
� �� �--� DATE TIME ✓
ITY OF ORONO CALLED IN � �
INSPECTION NOTICE Q SCHEDUIED a '� � C�
PERMIT NO. �C�� "�� 9�7 COMPLETED
ADDRESS ���%L � �')�?��//1 '�C� /`"��
OWNER TELEPHONE NO.���������g���
CONTRACTOR �L� � ��
� DESCRIPTION CFCiI /YJ�`�G Y�c'�'�"' ��r �fSf
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOILOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEP I FINAL ❑ FOUNDATION/REMOVAL
Z OWNERICONTRACTOR T-O_MEET YOU:�YES_NO
� COMMENTS:
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� ❑�WORKSATISFACTORY:PROCEED �OJECTCOMPLETE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITION WITHIN HOURS. � pHOTOTAKEN
INSPECTOR WlLL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call forthe next inspection 24 hours in advance. (952� 249-460�
OwnerlContractor on site:
Inspector.
White Copy/lnspector's File Canary Copy/Site Notice