HomeMy WebLinkAbout2017-00679 - gasline for future fire table � , CITY OF ORONO * z 0 1 7 - 0 0 6 7 9 *
2750 KELLEY PARKWAY DATE ISSUED: 06/2U2017
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2040 SPATES AVE
PIN : 10-117-23-31-0090
LEGAL DESC : ORA PARK ON LAKE MTKA
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : GAS LINE ONLY
VALUATION : $ 600.00
NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION.
GASLINE FOR FUTURE F(RE TABLE
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 030
PLUMBING RESTORATION&SERVICES LLC MAIL-IN FEE 2.00
889 PIERCE BUTLER ROUTE TOTAL 52.30
UNIT F
ST PAUL, MN 55104- Payment(s)
(651)253-1083 CREDIT CARD 5723 5230
Minnesota State License#:mech-MB005526
OWIYER
DAMMEN, SUSAN
2040 SPATES AVE
WAYZATA, MN 55391-
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 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 afrer 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. �
� �U /O / �
Applicant Permitee Signature Date [ssued By ' ature Date
Jun.21.2017 10:15 AM PLUMBING RESTORATION 6516662817 PAGE. 1/ 4
� � lt C' 1'Y C,SF;ONY.Y
C3ty of Orono �7 I �}
���0 P.O.Box 66 Datc Rocc� Pom�it# C�Q!�� �7./
2750 Kollcy Parkwau y�
Crystul Bay,MT155323 Approved E3y: Amount$:�, l./
Phone(952)249•4600 Fax(952)24y-441G
y�, �-
�q,��Tµ���,`' CITY OT ORONO--M�CHANICAL P�CRMIT
� (All C'ommercial pcnnits muat he a��pmved hy the Ruilding nIY"ieial or Inspector and/nr Pire Mershall)
� GENERAL INFORMA.TI4N
I. You may ap�ly for i�echatiic:al permits hy mail or in person at the City offices. Applications will
he r��vi�wod and a permit will be issued withi�l two working day5.
2. Permit cArds will be sent by z•etu�rn mazl afrcr�review is completed. PERMITS ARE NOT
VALID UNTIL YUU R�C�.f'VF A PERMIT. WORK MUST NOT$�GIN UNT.[L THE
P�RMJT CARD IS YOS'�ED O1V TIIE.TOB,��'��,,
3, MechanicaLDesisrns,Gomplot�calculations,detflils and specifications Are res�uired t'or eacl�
heating,vontilaCipn,humidification-dehumidification,and air condittoning installacion including
he�t loss/heat gaiu calculatioaa,design t�mperatures,equipment ratings and identificati�n as to
type,n�altufactur�r and model. Data sh�ll be presented on foi7n provided.
4. Wlieu�ny new constniction or remodeling is involved,a separate building p�rrr2it must be
obtflined.
5. All work�nust b�donc in accordance with the Uniform M.echa��iCa�Cod�/State Building Code
�•equia•e��4nts.
6. All worlc tnust be iuspected(rough-in and final). C�.11(9,52)249-4600.
(�q-48 hc�ur notice requiredj '
7. Houss Heating Test Record must be submitted bc�far�finaf,
TYPE OF P�RMIT
Check All That A 1
�,Kosidential ❑Coi�.nr►ercial(Approval Required) �Baektlow Device: � AV�3 0 P�VB]
❑ New �Additional ❑Repairs ❑ �.oplace
.�ob Site/Owner Ix�formation:
Site Address: ��� � � ��
Qwner: .`7�J�'N ���'��N IVlailing.A.ddxess;
City: V��I� � Zip: ��
Home Phone: A1tenlate Phoi�e: ��� ����'^`S` `✓
Contractor Tnform�tion:
Contractor: fi����vl3tN�_ _.��e��Contact Persoti; �
A,ddress: �`1 �6E�.�t�t.�-�' State Bond�: ���
City: .Sr_� Zip: S�a�Fxprration DatE: g �x —_� d 1�
Phone: ���`'2�� �b�� ralternate Phone;
❑ lnsurance—Current;
1
Jun.21.2017 10:15 AM PLUNIBING RESTORATION 6516662817 PAGE. 2/ 4
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MECHATTICAL SYSTEMS BEING INSTA�,LEI7
Note: All Geothermal Sysse�ns will now require a Sito Plan 8t R�vi�w by our�ui.lding af�cial,
IS THIS GEO'�'�E�2M.�.? ❑Yes �No
iiEATiNC SYSTEMS
QuantiCy;
Make:
Model: ,�.A,., _.
T'uel: ..W.,,.,,.. _
Flue Sizes: �_�.�....,.,..
InputBTUs; .._ ....._...__.__
Output BTUs: ,�,,,_�T
GFM: -�---.�_ .„.�.__
COOLING SYSTEMS
QuRntity; �_..�...
Ivl�ike:
Modol: �r..W_,.�
Tons: ,,.,".,.,.,� '
I1.Fower ,w
FIREPLACES
Q Gas Factory.Fireplace Brand Namc:
❑ Wood$uniing Fii�eplace
� Wood Stove Model No,;
❑ Wood Stove with I�lue/Masonry
VENTILATION
� No. „� I�itahen Exhaust duct racirculating cfin
❑ No. � Bath Exhaust(must have duct outside) cfm
❑
No. OtherFans: Lvcations _...... ........... cfm
FUEL STO + (ll�ust be apprnved by Fire Mprsha!!�f'proposl►rg to abandon tartk in pluC�)
(] Installation {� Removal
Fue!Oil: gallons ❑ Underground ❑Inside Q Outsid�
LP Gas: �a.11ons
Other: _
CAS LiNE ONLY
� CUutdoaz�Grill � Other/List Wl�at&WhEus: F�7�1�__ �`�/� 7i'4'�8�
2
Jun.21.2017 10:16 AM PLUNIBING RESTORATION 6516662817 PAGE. 3/ 4
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PERMIT FEE CALCULATIONS
1. �ONTRACT PR1C� "`is 1.25%oP contract price with A(Minimum Fee of S50.00)
�� x.U125�
(coniract prix) (mlaimum S30.W)
2. STATE SURCHAI2G� �,q,�
v" x.0005 $
(eontract prico)
3. POSTACfE�t HANDLING(Only on Mail-ln Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
■ * CONTRACT PRICF or ,IpB CUST means the actuA.l or estimated dollar unoi,uit claa��ged £or the
permitted work including tnator.ials, labor,profit,and other fixed costs: !t is the a,muunt tc�be charged
to the customer fbr che work done. If any materit►1,equip�aa8.nt,labor or installations�re fiimished by the
owner, tenant or any otlier party, the reasonabl� niarket vnlue of sucl� itenis must be added to the
estimated cost or coiatract price for permit fee ptu�poses, In the event that there is a disputo on the amounl
c�f the job ec�st, the City tnay request tl�e submission of a signed eopy of the aetual contract.
1vrECHANICAL PERMIT AFYL�CATION'AGREEMENT
The undersigned heroby applies to the City for issuanc�of a Mechanical Permit,agrees to do all
work in striet accordance with #he ardinances of the Ciry and the re�ulations of the State o£
Minnesota,and certifies that al)statements made on ihis application are complete,true and cotrect.
Applicant's Signature; w Date: ����"��
3
� � DATE TIME�
CITY OF ORONO CALLED IN �"���
INSPECTION �T� _�(� SCHEDULED �U,_
PERMfT NO. �' COMP ETED � �
ADDRESS �-�`�U ���-� t �
OWNER [ TELEPH NO. �� 2�3 � O��
CONTRACTOR `�` "� �"�
� DESCRIPTION ��"'" � 1�S ��''Q"
IV ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
� ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
2 ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
41 ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
v ❑ DEMO-SITE ❑ SEPTIC INSTALL
? OWNERICONTRACTOR TO MEET 11�U:_YES_NO
y COMMENTS:
� `�j� ry Gv �r � ,ns ���,e� �a �� �' _
o ^✓1� ����sss t�tidC� 4�'af�' 4�� ��s��
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W O WORKSATISFACTORY:PROCEED ❑PRWECTCOMPLEfE
� O�CORRECT WORK S PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� j�CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� ����' PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REOUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 2a hours in advance. (g52) 249-460�
Owner/Contractor on site:
Inspector: , / � �
C/
WhiM CopyAnspector's File Canary CopylSite Notke