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Home My WebLink About2013-00394 - mechanical � CITY OF ORONO * Z 0 1 3 - 0 0 3 9 4 * • 2750 KELLEY PARKWAY DATE ISSUED: 05/2U2013 ` ORONO, MN 55356- • (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3515 SIXTH AVE N PIN : 29-118-23-43-0002 LEGAL DESC : UNPLATTED 29 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : MECHANICAL(>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTTON TYPE : COOLING SYSTEMS VALUATION : $ 3,500.00 NOTE: AC UNIT APPLICANT MECHANICAL 50.00 COUNTRYSIDE HEATING&COOLING STATE SURCHARGE MECH(VALUATION) 1.75 6511 HWY 12 TOTAL 51.75 MAPLE PLAIN,MN 55359 (763)479-1600 PAID WITH CC# 7332 OWNER WOJCIESZAK,JOY 3515 SIXTH AVE N LONG LAKE,MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this pertnit 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 wnstruction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections aze requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. "1 V�`Nli(V � � / / Applican Permitee Signature Date Issued y nature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A VE. from:�OUNTRYSIDE HEATING & COOLING 763 479 2518 05l21/2013 14:03 #742 P.001/004 FOR CITY USE ONLY �O A'O City of Orono +y P.O.Box 66 Date Roceived: Pumit# 2750 Kellcy Parkway Crysral Bay,MN 55323 Approved By: , Amo�mt S: Phone(952)249-4600 Fax(952)249-4616 s �' �l�kESHOQ'�`` CITY OF ORONO—MECHANICAL PERMIT (All Commercial permita must be approved by the Bttilding Official or Inspector andlor Fire Mershell) GENERAL INFORMATTON 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 retum mail after a review is completed. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WURK MUST NOT BEGIN U1�iTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3. Mechanical Desi¢ns—Complete calculations,details and specifications are required for each hearing,ventilation,humidification-dehumidification,and air conditioning installation including heat loss/heat gain caiculation,design temperatures,equipment ratings and identification as to type,manufacturer and modei. Data shaU 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). Cail(952)249-4600. (24-48 hour noNce required) 7. House Heating Test Record must be submitted before final. TYPE OF RERMTT _. ' Check AlI That.A 1 �Residential ❑Gommercial(Approval Required) �` ❑New� ❑Additional ❑Repairs �Replace Job Site/Owner Information: Site Address: �� C..� K� lO J'�,, Q� ��,, ,— �l / Owner: l�-CII ��`+'u 501� Mailing Address: ��5 �S�— City: o�^�� _ Zip: ,5'S-�� Home Phone: �So�---`��`��3 7 Alternate Phone: Contractor Information: �� r/ , �/ � ) Contractor:(,.4N�� k �C�j Contact Person: r m l hQ G,�L�ij ✓ Address: �� W �� State Bond#: I� b �j(JJ�3 f � �� ' �J�..�9Ex iration Date: �o �v� �� City: � Gl l h Zip: p Phone: J]6 3 ,"�7�• �6�� Alternate Phone; Insurance—Current: �M(1`��`��V`� �YY�',� 1 From:GOUNTRYSIDE HEATING & COOLING 763 479 2518 05/21l2013 14:03 #742 P.0021004 '�� dF��1�Hk�.. :... .. . z_ . .. . . . �''r ,. � �. - .. .3 .. .» _ : . . r:.%�^}Brr.��L'N,t�.s7+�w k.__q+:d�" .4A. . .. -.. .... � � . ... ...� m... n. . ..._._. ..... . , '. . .. hote:All Geothennal Systems will now require a Site Plan&Review by our Building Official. IS THIS GEOTHERMAL? ❑Yes ❑No HEATING SYSTED'IS Quantity: ---- ----- Make: . Model: �� __ Fuel: � _ _ _. Flue Size: _ Tnput BTUs: �__ `..._ Output BTUs: __ __ �� ____ CFM: — -- -- ---- COOLING SYSTEMS Quantity: �� Make: C1N�� . - ----- --- -- Model: �o�,�_ 1"t�t'� - -------_—.__----- Tons: __� _ �__.�_ H.Power �6 �� 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 Exhaust(must have duct outside) cfm ❑ No. Other Fans: Locations cfm FUEL STORA.GE (Must be approved by Fire Marshall if proposing to abandoa tank in place.) ❑ Instailation ❑ Removal Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside LP Gas: gallons Other: GAS LINE ONLY ❑ Outdoor Grill ❑ Other/List What&Where:_ , 2 From:GOUNTRYSIDE HEATING & COOLING 763 479 2518 05/21/2013 14:03 #742 P.003/004 4}. ...._ ,; ...�,. .. .., _ - �=��^��,;�x �: : �; _. .. t .. ._ . . „ � ,. • ,. 2 � 5: �, x� . . . . .. . y '. ' ' .�,, �s;�t�^��". . .. � ❑ Yes,this section applies The replacement of a Residenrial fixture or annliance 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;excludine the cost of the fixture or appliance:and 3. Is improved,installed or replaced by the homeowner or licensed contractor. Skip next section,if this applies; Cost of Permit $ 15.00 State Surcharge $ 5•00 Mail-In Fee(If Applicable) $ 2.00 Totai Permit Fee $ =��_ �t��' :��r,.,. �. . . .. .,.. '� _ " �.. �. , ..,. 3�'Y1..�i-,��..�.�•�.�' . ., � w� '�. If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) �5�� x.0125$ (contract price) (minimum 550.00) 2, STATESURCHARGE x .0005 $_____ (ccmtract price) 3. POSTAGE&HANDLING(Only on Mai]-In Applications} $ 2.00 4. TOTAL PEItMIT FEE(Add Lines 1-3 Abovc) $ c��• 7� ■ * CONTRACT PRICE or JOB COST means thc actual or estimated dollar amount charged for the permitted work inclvding materials,labor,proft,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. .._, . ,_. f �., _. 3i "S-y',4r y��'.� ....,:.. .,� ..:... sx�.�''�.2s�'_..� �'].k':".� . . � . .' a,. �' ' •: rd .. .... .. ... .».. _ .. . . 1_. . ._.. . 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: ��—'�(��l� 3 From:GOUNTRYSIDE HEATING & COOLIN6 763 479 2518 05l21/2013 14:04 #742 P.004/004 �.; -- , , .. , F Ciry of�t. Louis Park � } � ? This is!o certify that Craig Sehumacher is the holder oflhe following ; ` Certificate(s)oJCvnrpe�ency, valid unti112J3U2015: . ' � Proof of d CEU's in Mechanical Code related training will be required � : at time of renewal. _ Applicant TD: 719 ; . Conditioned A�r. ` Craig Schumacher �� 30880 Co Rd#20 Steam i Delano MN 5532$ , � i . �. ,� $oard ofExatiiinGrs � ; - . � ._ ._ � �. . ............._........._.__......_... .:....__....._.._._..............._.__.::.._............__... , �LABO' �ItNNESOThDEPAqT1dCIJTDi T'ECHNOLOGY SYSTEMS.CONTRACTQR R &INDUSTRY Consuuctwn Codes and Licensing Division Licensing and Certilication Services 443 LalayeHe Road N Sl.Paul,MN 55155 Website www dii_mn oovkcki ne� Emai1 �Ii.iicense(�state mn ua Phone: 6512B4.5034 7'his is to certify that the ceriificate holder is licensed as a TECI-INOLOGY SYSTEMS CONTRACTOR in the state of Minnesota and is in compliance wich Minnesota Statutes 326B.13,Subd. 14,and may perfomi or offer to perform the installalion,maintenance,and repair of electrical wiring,appazatu.e,and equipment for technology ciruits and systems during the license period;provided the responsible individual is at aU times a POWER LIMiT'ED:TECHNICIAN and the certificate holder maintains compliance with the required bond,general liability insurance,and workers'compensation laws. License : TECHNOLOGY SYSTEMS C�NTRACTOR Lic Number : TS000172 COUNTRYSIDE WEATING&COOLING SERVICES INC Effective Date : 08/09/2012 g511 NWY 12 Expiralion Date : 07/31/2014 MAPLE PLAIN, MN 55359 VERIFY t1P-TO-DATE S7ATUS, BOND,AND INSURANCE INFO AT www.dli.mn.�ov/ccld/�icVerifv asn (ENTER NUMBER). e"�� MIN.NC$OT/�DEPARTM[NT61' ��'�`°'��L C�N 1 �ACT� LiVNiJ ( LA90R & 1NDUSTRI' m Conslrudion Codes and Lkensinp Divbion �icensinfl and Cer116ca1ion Seryices 4e3 Lalayene Road N SI Paul,MN 55155: Websi�e� www tlll din norkc asn _ : Email: dli Gce�seC�stale-rm,us � � Pliorie: 651.284.503a - y,. -. � .. .. 7'6is�s to etrtify tfiat the certifiCaie}iDldcr is rcgist�ed as a MECHANICAL CONTRAC7'OR BOND in the sWte of Mienesota and is in compliaace with Mmnesola Statutes 3269.197,and has filed a 525,000 mechanical bond to perform gas,heating,vrntilation,cooling,air conditioning, fucl burning,or refrigcration work in all areas of the state during the registration period;provided the work performed complies with the State NJxhanical Code and the cenificate holder mainUins compliance w�t��he requircd bond and workers'compensation laws, Registration : MECHANICAL COMTHACTOR BOND RegNumber : M8005313 COUNTRYSIDE HEATING & COOL{NG SERVICES II�C Eltective Date i 06/30/2012 6511 HWY 12 - • Expiration Da1e : 06/30/2014 MAPLE PLAIN, MN 55359 . ' From:GOUNTRYSIDE HEATING & COOLING 763 479 2518 05l21l2013 13:52 #741 P.001/001 � � City of Orono Building Permit Application for Maintenance / Replacement / Renovation (No structural expansion. Only windows, doors, siding, re•roof, etc.) �OA'O Mailing Address: Permit number: +y PO Box 66 Crystal Bay,MN 55323-0066 Date received: Street Address: ��by' � �C' 2750 Kelle Parkwa y�. G� Y Y Plan review fee: Orono,MN 55356 !�'ff5H0�� Total Fee: Main; 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. lncomplete applications will be returned. (P/ease print) GENERAL INFORMATION: �5/� /1 j} � /' Job Site Address: (�O 1�;0{ �O Will this be a Parade of Homes,Remodelers Showcase Home or other Qisplay Home? Yes No ff yes,a specia/event permit is requlred wlth Police Department and CIry CouncA approva!60 days prior to the event. Shuttle bus servic�e wi!!be requlred un/ess applicanf demonsMates sulrcient on-site parking is availab/e. Non-permitted events will nof be allowed. CONTRACTOR/ PLICA T INFORMA'�ON: , Name: � .)Q•r✓�� State License# `� /'] Expiration Date: `") 3 O/ Lead Certification Number: Expiration Date: (ior work on homes tha!►+�ere constructed pr/or to 1978 Phone: (celI) —76 3 .��7 . 6 O c"� (office) Mailing Address: �"' �y / ciry: a q• Zip: 5-5 Contact Person: �Y, �e., Applicant is Contr tor Homeowner (CirclaOna) Email andlor Fax: , �/ PROPERTY OWNER INFORMATION: � n � � Name: E'.� � p•�'S O� Phone(day): ��'�_L,/& �3 � Address: _��'75 �'� � City: ZIP: S S�c��p Email andlor Fax: PROJECTINFORMATION: Overall ro�ectdescri tion: C ��''1� � �7` ��Ni-� Type of Project: Any earth movement m y also require � ❑Door(s) ❑Remodel ❑Fire Damage MCWD review 8 permits: ❑Re-roof,asphak ❑Repair ❑Storm Damage Minnehaha Creek Watershed District(MCWD) t8202 Minnetonka Blvd ❑Re-roof,cedar ❑Restoration ❑Water Damage Deephaven,MN 55391 Phone: 952-471-0590 ❑Re-roof,other(specify) ❑Siding ❑Other.(specify) Fax: 952-471-0682 ❑Window(s) www.minnehahacreek.oro Estimated Construction Valuation of Project(excluding land) $ 350�. pp APPLICANT ACKNOWI.EDGEMEN7: • Agrees to provide all information required or requested by the Building Department; • Certifies that the information supplied is true and corcect to the best of his/her knowledge. The applfcant recognizes that they are solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no altemative but to reject it until it is complete; • Some or all of the information that you are asked to provide on this application is classified by State law as either private or confidentiaf. Private data is information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and intended use of this fnfortnatlon is to annually update our records and records of other govemmental agencies required by law. If ou refuse to su I the infor tion,the a on ma not be issued. Applicant's Signature: nate: �— l— � Owner's Signature: Date: Las!Updated:03/06/2013 DATE TIME � CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO.o�/t3•lJ�3��'1 COMPLETED �/j� ADDRESS 3 S�S vrs�ct� ��G. OWNER TELEPHONE NO. CONTRACTOR Ca��ry�e ��o, � DESCRIPTION —�G /�� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING �EEGNANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION � WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB O WATER HOOK-UP ❑ PROGRESS � ❑ FINAL 0 SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. FOLLOW-UP = p DEMO-FINAL O SEPTIC INSTALL ❑ ARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNbAl10N/REMOVAL 2 �MNERICONTiiACTOR TO MEET YiOU:_YES_NO y COMMENTS: a �/G /�D/ � � 0 � ��r�c.r;G r�n..�,�.� --- 0 � � Q �,up!'�C �.Deav.S ��Z`e � 2 � W � � J � ❑WORK SATISFACTORY:PROCEED '�ROJECT COMPLETE W ❑CORRECT NfORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECTNfORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. O PHOTO TAKEN INSPECTOR NfILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 2a hours in advance. (g52) 249-46�0 OwnerlContractor on site: Inspector. �t r � [/ White CopyAnspector's Flle Canary CopylSite Notice