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Home My WebLink About2010-00408 - mechanical . — . CITY OF ORONO PERMIT NO.: 2o�aoo4os , 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 06/OU2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 2920 SOMERSET LA PIN : 04-117-23-21-0012 LEGAL DESC : OLD CRYSTAL BAY ROAD 2ND ADDN : LOT 005 BLOCK 003 PERMIT TYPE : MECHANICAL(>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : COOLING SYSTEMS VALUATIQN : $ 3,500.00 APPLICANT MECHANICAL 50.00 FLARE HEATING&AIR COND STATE SURCHARGE MECH(VALUATION) 1.75 9309 PLYMOUTH AVE N SUITE 104 MAIL-IN FEE 2.00 GOLDEN VALLEY,MN 55427 MISC FEE 0.00 (763)542-1166 TOTAL 53.75 OWNER FIRST,LANCE&MEREDITH 2920 SOMERSET LA LONG LAKE,MN 55356- AGREEMENT AND SWORI�i 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 sepazate permits. Atl 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 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 causk. � `''yYt�'� Li�t l l � � Applicant Permitee Signature Date Issued y Si ture ate SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO 53. �S � Uv �- 8�:3 � - �, FOR CITY USE ONLY ¢p—� City of Orono '�' � P.O.Box 66 Date Received: Permit# ��;,, ,, �` 2750 Kelley Parkway � ��'�Y: . !� Crystal Bay,MN 55323 Approved By: Amount$: � i�y�!�aiyGC (952)249-4600 ��H� CITY OF ORONO—MECHANICAL PERMIT (All Cmrunercial 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 UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3. Mechanical Desiens—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) ❑ New �✓ Additional ❑ Repairs ❑Replace Job Site/Owner Information: Site Address: 2920 Somerset Lane Owner: Meredith First Mailing Address: 2920 Somerset Lane Cit Orono Zi 55356 Y� p� Home Phone: �952)476-6373 Alternate Phone: �916)690-2154 Contractor Information: Contractor: Flare Heating &A/C, Inc Contact Person: Randy Imker Address: 9303 State Bond#: MN25263 City: Golden Valley Zip: 55427 Expiration Date: 07/31/10 Phone: (763)542-1166 Alternate Phone: ✓❑ Insurance—Current: 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: ModeL• Fuel: Flue Size: Input BTUs: Output BTUs: CFM: COOLING SYSTEMS Quantity: � Make: LG Model: LAN121CNP LAU121CNP Tons: � H.Power FIREPLACES ❑ Gas Factory Fireplace Brand Name: ❑ Wood Burning Fireplace � Wood Stove Model No.: ❑ Wood Stove With Flue VENTILATION ❑ No. Kitchen Exhaust duct recirculating cfm ❑ No. Bath Exhaust(must have duct outside) cfin ❑ No. Other Fans: Locations cfm 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�Vhat&Where: 2 � PERMIT FEE CALCULATION(S) , BASED OFF-2002 STATE STATUE ❑ Yes,this section applies The replacement of a Residential fixture or anpliance 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 $ I 5.00 State Surcharge $ .50 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$50.00) 3,500.00 x.0125$ 50.00 (contract price) (minimum$50.00) 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50) 3,500.00 x.0005 $ 1.75 (contract price) (minimum$ .50) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 53.75 ■ * 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. ■ **The STATE SURCHARGE is.0005 of the Building Department at(952)249-4600 for the price. 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: Date: Reset Form 3 , � • '� �A`oRo� CERTIFICATE OF LIABILITY INSURANCE 4ii�2oio' PRODUCER (g52)707-8200 FAX: (952)890-0535 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Kraus Anderson Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 420 Gateway Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. � � Burnsville NIld 55337 I INSURERS AFFORDING COVERAGE I NAIC# wsuReo I,�NsuRERA:Acuity A Mutual Insurance Flare Heating � Air Conditioning, Inc. jiNsuaeRe:Star Insurance Co. 9309 Plymouth Avenue N ;�iNsuaeRc: ' Slllt@ ZO4 �I INSURER D: Golden Valley hII1 55427 I iNsuReR e: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTAN DING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCIUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'U � POLICY EFFECTIVE !POLICY EXPIRATION i LIMITS � POLICY NUMBER � ��, ��ERAL LIABILITY �� I EACH OCCURRENCE �'�,E 1 OOO OOO ', _X I COMMERCIAL GENERAL LIABILITY i I I (PREMISES(Ea oaurtence) i$ 25O,OOO A '� _�_'!Cu+IMSMADE 'ii X li oCCUR�L804B1 j 4/1/2OlO �4/1/2011 �MEDexP(Anyoneperson) � lO OOO � PERSONALBADVINJURY ';$ 1 OOO OOO ,, _--, .-- , �'I II I __ , . I_GENERALAGGREGATE i$ 3 OOO OOO ' �GEN'L AGGREGATE LIMIT APPLIES PER:�, I 'I F PRODUCTS-COMP/OP AGG I 3 3 OOO OOO . ,--�',POUCY rX i PRO� ��LOC �, �� , �. AUTOMOBILE LIABILITY '� � I I COMBINED SINGLE LIMIT '� � (Ee accident 'a 1 i 00�i�� ' ',f R I ANY AUTO i �� j ) i A � � _�.ALLOWNEDAUTOS �L80481 �i 4�1�2O10 I 4�1�2011 I gpDILYINJURY � '.. '� ^i SCHEDULEDAUTOS '' I I �erperson) �§ � � � �i! i X i HIRED AUTOS i � i BODILY INJURY '��,S �� 'I I(Per accidant) I '�,XJ'NON-OWNED AUTOS �, i i � I f i ' ,— . ' � ' I PROPERTY DAMAGE �,a �. I ' I i �(Per accidenQ i ��. ��GARAGE LIABILITY � ,� '� I AUTO ONLY-EA ACCIDENT �E I �__�ANY AUTO '�,,� '� I �OTHER THAN �A��I$ � _ �. � ''� �AUTO ONLY: AGG�$ i � ��_EXCE551UMBRELLAUABILITY ��, I I FEACHOCCURRENCE '$ 3 OOO OOO �'�, �� X ��,OCCUR �__i CLAIMSMADE !i I �AGGREGATE �S 3 OOO OOO ,��, �. �I i � ' i$ A �I �e�ucrie�e �,so4ei ;4/1/2010 4/1/2011 �_ 's I I X I RETENTION E 0; I � i g B !WORKERS COMPENSATON : � ': ,'X I WC STATU- I OTH•; I AND EMPLOYERS'LIABIUTY �� ' i i TORY LIMITS I ER �� Y/N '� ANY PROPRIETORIPARTNER/EXECUTIVE I� ; I E.L.EACH ACCIDENT !E r'JOO OOO ;OFFICERIMEMBER EXCIUDED? �� I, --� ;(MandatoryinNH) ��1463 I 4/1/2010 �j 4/1/2011 E.L.DISEnSE-EAEMPIOYEE'S 500 000 '�,If yes,descnbe under '� � — �SPECIAL PROVISIONS below � �I I �� E.L.DISEASE-POLICY LIMIT'�S $OO OOO �'�OTHER �� I . i �I ' �I i ' j i � DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISiONS CERTIFICATE HOLDER CANCELLATION (952)2 4 9-4 616 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATON Cl t17 OP O2'OAO DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3� DAYS WRITfEN Z�I�J O Kel ley Parkway NOTiCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Crystal Bay, IvIId 55323 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AU7HORIZED REPRESENTATIVE Meghan Tschida/MTSCHI J�yff�'�""—�'�"� ACORD 25(2009/01) O 1988-2009 ACORD CORPORATION. All rights reserved. INS025�zoosoi� The ACORD name and logo are registered marks of ACORD � ti�r�.t;:; � :��+.ir, . ,,:,:: � L/�BGR&INDUSTRY . LABOR & IhIDUSTF'iY — r Construction Codes and Licensing Division Construction Codes and Licensing Division Commissioner of Labor and lndustry Commissioner of L�bor and Industry Has Recei��cd and Filed a�25,000 Surety Bond, ;1s Required by�IS 326.992,1'or\Vork Regulated Has Received and Filed a $25,000 Surety Boud� by the St�tc�Icchanical Code As Required by MS 325.992, for Work Regulated To; �i��n:��d�,Gucrre Bond\o: h1N z��63 by the State Mechanical Code H�au-c Ileating&Air �1I3 ID:00?2� Conditioniug Bond No: MN 25263 tiffecti�e Date Expiration Date Richard L Guerre ��31�200y 7%30/?0�0 To: Flare Heating&Air Conditioning MB ID: 00225 9303 Plyniouth Ave. N. Suite 104 Golden Valley MN 55427 Effective Date Expiration Dale nneFormRC 7/31/2009 7/30,�2010