HomeMy WebLinkAbout1994-006329 - furnace/ac/vent PER�VIIT
CITY OF ORONO f �' P�Rn�y�r �rvP�:
2750 Kelley Parkway • P.O. Box 815 Permit Number: °��� ��"''�'���- �` � '
Orono, Minnesota 55356-0815 �}'-�'_�•�i�='
(612) 473-7357 Date Issued: �};:i j�:�,��
SITE ADDRESS:
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FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF ORONO APPLICATION FOR 1VI�CIiANICAL PERNIIT
Box 66 (2750 Kelley Parkway) , � � Z ��- `,�e��
Crystal Bay, MN 55323 ���) 1 � 1��4 �``�� �
GEIV�RAL INFORII�IATION
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 2 working days.
2. Pernut cards will be sen[ by return 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 Designs - 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. Identification of and specifications for water heating equipment
shall also be provided.
4. When any new construction or remodeling is uivolved, a separate building permit must be obtained.
5. f�ll work must be done in accordance with the Uniform Mechanical Code/State Building Code
requirements.
6. All work must be inspected (rough-in and fmal). Call 473-7357. 24-hour notice required.
7. House Heating Test Record must be submitted before final.
Instructions Complete all items on this application. Compute the permit fee. Sign and date the certification.
INCOh1PLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call 473-7357.
Please check one: New � Addition Repair Replace
�C Residential Commercial
JOB SIT'E: ��s- �/`'/�ri� /�t/�- Zip: -S S� �/
Owner's Name: �.P,41 G rf�s�r�r�.8��c, TelephoneNumber: ��s-�o��
Mailing Address: ���-�S��T�+ �v P . City: Ur2o���� Zip: .�s3`-3i
Contractor'sName: ��=�u T,�'�/i�E , z�v� . TelephoneNumber: " �'��-�"y�{
MailingAddress: ���=N i"����� � City: /"��'�-' Zip: 5 s-3`�`Y
SYSTEM DESCRIPTION
HEATING SYSTEMS
Quaniiiy: �
Make: L������'�
Model: l z���y-���
Fuel: /c� �,
' Flue Size: z '�u�
Input BTUs: /L�v�uv�
Output BTUs: �2 � c�
CFM: ��a��
COOLING SYSTEMS
Quantity: �
Make: ��:��i��
Model: �/S�-�//
Tons: �
H. Power
�U � �. °'�.�
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ts . .
WOOD BURNING EQUIPNiENT
Wood stove with flue
Wood combination or add-on
Factory fireplace with flue � '
Factory Fireplace (s) Freestanding Masonry
Wood Stove (s) Franklin, other
Brand Name Model No.
Mfgr's Min., Clearances, side , rear , min. flue dia.
Total
VENTILATION
No. Kitchen Exhaust ducted recirculating cfm
No. �3 Bath Exhaust (must be ducted outside) /�� cfm
Na. Other Fans: Lc�cationc cfm
Total
FUEL STORAGE (MUST BE APPitOVED BY FIRE MARSHAL)
Installation Removal
Fuel oil: gallons underground inside outside
LP Gas: gallons
Other Gas opening
PERMIT FEE CALCULATION
1. 1.25% of Contract Price* or Minimum Fee ($35.001 _
`7��c�v — x 1.25 $ �C��
(contract price)
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit. `7 z ���� x .0005 $ 3 c� u
(contract price)
3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (Add line� 1-3 above) $ �S� /��
* 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 chazged to the
customer for the work done. If any material, equipment, labor, or installation are fumished 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 STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
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 Ciry and the regulations of the Minnesota
State Building Code, and certifies that all statements made on this application are complete, true
and correct.
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ApplicanYs Signature: � , (, '— Date: - ��- � �
Approved By: � � Date: "��`��
0 P.c+. c9tS s P.v�.
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HOUSE HEATING 7EST RECORD
ADDRESS .��� � 1'� �� � �
� ���, APT. FLOOR CITY ���"� ��UBURB
OCCUPANT �' '=� t'• 1"f "" Z�_Fl��OWNER a„�
HEAT LOSS DA E HTG. INST. 3,-' •��` ' }� ',`
SOLD BT _ C�.�=,���w t' ���,'"�-- INSUl.LEO BY . .-. `SQI"�- "� �-��Y ti` ��� -
El.chicol Work Br C���t="' Ge• Lin�.J� ' � ♦��—
TYPE OF MEAT GA FA �.HW STEAM _—___SPACE HTR.�� g� . OTHER
GAS DESIGN G�� CONVERSION
MAKE �-�',i.a�'��.-' x AIAKE OF BURNER
� �.� _ �
Mod�l �'�-�{�'�d?��["L'��_—L_ __IAod�! _
C'•�✓_% -s [ �
5«iol _ -� � � 7L _�..(�' Q''�/ -- Mox. BTU Rariny
INPUT ��� �.�'!` .�:�41t��a __ MAKE OF FURNACE
Mod•I _
CONTROLS j
THERMOSTA,T(.� T�7 �� H�ot Plup V�nt S�:• � I l?L�` "�
Volr• __��-�.�%'l`P . ___ KIND OF LINE SIZE NONE �-=---'
Limit "'�� ,�E(•��� [�� � �G' �� Drah Hood —�='�'� � R�pularor �1 '� =�
Limit S�Hiny �%'t� - -- FiltNs Sis• /�'�'.}"'�:��— Mumb�r �
" � ,
Fan 5�►tiny ��W1�f ( ����(.' �"- (}fmn�y Location Insid� ^" Outaid•
Pilot Typ� _ �,,��=1'�[L�c�"tCri�� Chimn�y Co�shuefion "'"�—
Pilot Mok� _ �t1�r�lS�v� L�."►�"�-!S
—�
Pilot Modsl __�4 H c��:(,J _ Smok� Bomb _ �-� Wiriny �,/
Pilot Timin9 �� Draff �'� T�st Top L�
L.W. Cut Off —_ ` Dow Pr�ssw• Liyhtiny Inst. �;.�
i�� sr
Pnssur• _���'✓ P�rcenf COZ — � Dat� T�st�d _ � ',�*,�=�r.�
Input CFH_� P�rc�nt 02 Comyony Tesfiny �--ty''Ct!`:1�i�' ��_ -
$rock Tamp. P�rc�M CO ' y " � '� Nan» of T�st�r _���