HomeMy WebLinkAbout2016-01155 - mechanical � � ' CITY OF ORONO
2750 KELLEY PARKWAY * 2 0 1 6 - 0 1 1 5 5 *
DATE ISSUED: 09/2U2016
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 1580 SIXTH AVE N
PIN : 26-118-23-32-0006
LEGAL DESC : REG.LAND SURVEY NO. 1418
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : COOLING SYSTEMS
VALUATION : $ 2,906.00
NOTE: REPLACE:A/C UNIT(LENNOX)
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 1.45
GENZ-RYAN PLUMBING&HEAT TOTAL 51.45
2200 HIGHWAY 13 Payment(s)
BURNSVILLE,MN 55337 CHECK 157157 51.45
(952)767-1000
Minnesota State License#:mech-MB003541
OWNER
HILL,DARIN L
1580 SIXTH AVE N
LONG LAKE,MN 55356-
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 dces
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing 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 1 SO 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., t�/n
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Applicant Permitee Signa re Date Issued By Signature Date
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FOR CITY USE ONLY �
City of Orono (� /�'��
` �-O� P.O.Box 66 Date Received:� �IPermit# ��'� l.!� `
O 2750 Kelley Pazkway /,
Crystal Bay,MN 55323 Approved By: Amount$: Lf'�r
Phone(952)249-4600 Fax(952)249-4616 �
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`� �.�' CITY OF ORONO-MECHANICAL PERMIT
la'FES H 04 (All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall)
GENERAL INFORMATION
1. You may apply for mechanical pernvts 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 retum 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 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
�Residential ❑Commercial(Approval Required) [Backflow Device: ❑AVB ❑PVB]
❑New ❑Additional ❑Repairs I�J Replace
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Job Site/Owner Information:
Site Address: � S� �p� � �
Owner: ����n Ct1'I Mailing Address: ��J� ��7�"�(.r /U
���: ��La-�c,�. Z�p: 55 3 S�
Home Phone: "Ja7- ��- ,3� � Alternate Phone:
Contractor Information:
Contractor: �`���-- GL.�'1 Contact Person: �r'�� Na-��-S
Address: (���J W rr� �3 State Bond#: �6 OD 3S y I
City: '�l,lX'�'1Si�9 Zi�CJ"__��Expiration Date: O �S �
Phone: �a�107"L�OU Alternate Phone: 95 0�'��7-��o�
❑ Insurance-Current: ve S
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Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS THIS GEOTHERMAL? ❑Yes�'1�10
HEATING SYSTEMS
Quantity:
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make: ��
Model: l g��
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 cfm
❑ No. Bath Eachaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfin
FUEL STORAGE (Must be approved by Fire Marshall if proposing 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:
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.+
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1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum F of$50.0
a 90� X.o�25$ � �o �o�
(contract price) ( inimum$50.0�
2. STATESURCHARGE
��v� X.aoos $ � �
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ . 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
pernutted 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.
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: U � �
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