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Home My WebLink About2013-00169 - mechanical CITY OF ORONO * Z QJ 1 3 — 0 0 1 6 9 * . 2750 KELLEY PARKWAY DATE ISSUED: 03/19/2013 , ' ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 951 SPRING HILL RD PIN : 26-118-23-44-0002 LEGAL DESC : UNPLATTED 26 1 18 23 : LOT 000 BLOCK 000 PERMIT TYPE : MECHANICAL(>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : �-MULTIPLE n'lD-C�I'`� VALUATION : $ 10,122.00 NOTE: INSTALL LENNOX FURNACE&A/C APPLICANT MECHANICAL 126.53 SEDGWICK HEATING&A/C STATE SURCHARGE MECH (VALUATION) 5.06 1408 NORTHLAND DR-SUITE 310 MENDOTA HEIGHTS, MN 55118- MAIL-IN FEE 2.00 (952)881-9000 TOTAL 133.59 OWNER PASTEL ET AL TRUST,JOANNE M 951 SPRING HILL RD 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 pertnission 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 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�le cause. `�'li�t.c.Q C� / / G�'Y►(,�—r(_ l l Applicant Permitee Signature Date [ssued By gnature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A VE. �`' ��-►.�r�r-��C'.��C� i n S'�� l/ -�v.r -�i�r� — �a p� c.��C_'�i�<,•K i,-� rha i I -��d� s r 4 FOR CITY USE ONLY , � �` City of Orono ��i Gf✓ti t� !% gO`�'�' P.O.Box 66 Date Received: 3 J� /3 Permit# �13—�� yUL�j, . +"1 '��, _ �`�� 2750 Kelley Pazkway t� I i�'� �;y'�. � Crysta Ba,y,MN 55323 Approved By: Amount$: ��► �,2a� a o�� PF�one(952)249-460b Fax(952)249-4616 ��xo.� . __ __._ __ -> �/.�3.s��1 CITY OF ORONO-MECHANICAL PERMIT (All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall) �/"�/CGl� _..�t.1/ � GENERAL INFORMATION 1. You may apply for mechanical permits by mail ar 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,des�gn 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 [�eplace Job Site /Owner Information: � � f Site Address: J � �i f1� � 1 i ` O�' c1 Owner.�> ��l�C'_ ��`�T�= Mailing Address: �"� J -��i 1�, � � ��.. City: �(G�i�1 C� Zip: �,.,�� . Home Phone: �5�- �I�(�- I 13 U Alternate Phone: (1�I�- `l l U " �� S j�' Contractor Information: Contractor: Contact Person: ��J � SEDGWICK MEATING i AMi CONDI?�NMIG llC 1408 Nathq'hd Drfw Suile 310 Address: Merwoh t�ej nts,�sstxo State Bond #: gY��;�� ( y � City: Zip: Expiration Date: {I � y � I � Phone: Alternate Phone: „ ❑ Insurance-Current: ('�;�,.� ��,i,;.�a� 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 Quantiry: ��-�'�I'� v 1.=�� Make: ��(1 l 60U��UC Model: Fuel: Flue Size: Input�3TUs: i I L' i c'C:l�� Output BTUs: CFM: COOLING SYSTEMS Quantity: `��r?'YL'vt,�,r� Make: ��X 0 Model: Tons: � H. Power FIREPLACES ❑ Gas Factory Fireplace Brand Name: ❑ Wood Burning Fireplace ❑ Wood Stove Model No.: ❑ �a'oo� �tcve wit!: Flue!'�4asonry VENTILATION ❑ No. Kitchen Exhaust duct recirculating cfm ❑ No. Bath Exhaust(must have duct outside) cfm ❑ No. Other Fans: Locations cfm FUEL STORAG E (Must be approved by Frre Mars/ia//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: 2 . + PERMIT FEE CALCULATION(S) BASED OFF - 2002 STATE STATUE ❑ Yes,this section applies The replacement of a Residential fixture or appliance 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; excludin�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 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) io � i�� X .o�zs $ I�C�,�3 (contract price) (minimum$50.00) 2. STATE SURCHARGE /' �V, ��v� _vv x .0005 $ �. ��'� �(contract price) 3. POSTAGE& HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � J � � J CI ■ * 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 ar any other party, the reasonable market value of such items must be added to the es±imated cost or cen±ract rrice fer pPrr.�it fee �um�ses. In ±he event that there is a d�spute on the amount of the job cost, the City may request the submission of a signed copy of the actual contract. 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. � � �� I� Applicant's Signature: [� Date: � Reset Form 3 A�� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYW) io/a9/sois 'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 133UING INSURER(S), AUTHORIZED REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If tl�e certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certlflcate does not confer rfghts to the certificate holder in Ileu of such endorsement(s). PRODUCER 1-952-358-7500 CONTACT R1m SSII89II Arthur J. Gallagher Riak Maaagemeat Services, Inc. PHONE FAx . 952-358-7522 ac No: 952-358-7501 3600 American Boulevard 1Peet E�A�� kimberl hansen�a c� ADDRES3: Y j9• Suite 500 Bloomingtoa, �i 55431 INSURER 8 AFFORDING COVERAGE NAIC# INSURERA: OHIO SHCQRITY INS CO 24082 INSURED INSURERB: �HI� �$ =NS CO 24074 SHAC LLC dba Sedgvvick 8eating � Air Coaditioning �ggT Al�R INS CO 44393 INSURER C: 1408 NOithlaad Drive INSURERD: ffieadota Heights, �i 55120 INSURErtE: INSURER F: COVERAGES CERTIFICA7E NUMBER: z9884938 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE �►DDL UBR pO�ICY EFF POIICY EXP L1MR3 LTR POLICY NUMBER MMIDDMIYY M DDIYYYY A GENErtALLu►BIUTY BR854885052 10/29/1 10/29/13 Ep,CHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY R 400,000 PREMISES Ea accurrence S CLAIMS-MADE �OCCUR MED EXP(Arry one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ a,000,000 POLICY X PR0. X �� S �► AUTOMOBILE LIABILITY HAS54885052 COMBINED SINGLE LIMIT Ea acadent 1,A00,000 7[ qryy p�p 80DILY INJURY(Per person) Z ALL OWNED SCHEDULED BODILY INJURY(Per acadenl) Z AUTOS AUTOS NONAWNED PROPERTY DAMAGE a HIRED AUTOS AUTOS Per accidenl a B X UMBRELLALIAB X p�CUR US054885052 10/29/1 10/29/13 Ep,CH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS•MADE AGGREGATE $5,000,000 DED X RETENTION$10,000 S C WORKERSCOMPENSATION Xpip�54885052 10/29/1 10/29/13 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE❑ N�A E.L.EACH ACCIDENT $ 500�000 OFFICERIMEMBER EXCLUDED9 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S 500,000 M yes,desaibe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT E DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attaeh ACORD 101,Addklonal Ramarks Sehedula,If more spaee Is requlred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Orono THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2750 Relley Parkway AUTHORIZED REPRESENTATIVE Oroao, !�i 55356 -fi � �(/L��_ �� USA u.s,rwr.- v��.��f.a �1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD praveenminn 29884938 �� :� �ea�&ir�ousT�r MECHANICAL CONTRACTOR BOND � � Consmiction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road N St Paul,MN 55155 Website: www.dli.mn.govkcld.aso Email: dli.licenseCa'�siate.mn.us Phone: 651.284.5034 This is to certify that the certificate holder is registered as a MECHANICAL CONTRACTOR BOND in the state of Minnesota and is in compliance with Minnesota Statutes 326B.197,and has filed a$25,000 mechanical bond to perform gas,heating,venrilarion,cooling,air condi6oning, fuel butning,or refrigerarion work in all arcas of the state during the registration period;provided the work performed complies with the State Mechanical Code and the certificate holder maintains compliance with the required bond and workers'compensation laws. Registration : MECHANICAL CONTRACTOR BOND � RegNumber : MB004143 SEDGWICK HEATING &AIR CONDITIONING � Effective Date : 11/04/2012 1408 NORTHLAND DR STE 310 e Expiration Date : 11/04/2014 MENDOTA HEIGHTS, MN 55120 T VERIFY UP-TO-DATE STATUS, BOND,AND INSURANCE INFO ATwww.dii.mn.aov/ccld/LicVerifv.asa (ENTER NUMBER). � J' i �A� TIME ✓ CITY OF ORONO CALLED IN INSPECTION NOTICE Q SCHEDULED �7�� PERMIT NO.oZB/�i— L��O-1 COMPLETED ADDRESS �S � ��'�'l�F �� f�� OWNER�D�( �G�-1 � TELEPHONE NO. �O�o� ��O Z�� CONTRACTOR�e >: DESCRIPTION �;`%y�� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICALRI ❑ LAKESHORENVETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL BING RI AL ❑ FOUNDATION/REMOVAL OWNERI NTRACTOR TO ME YOU: YES_NO c., MMENTS: � W a � J O � � O � W � Q � Z W � W � j � ❑WORKSATISFACTORY:PROCEED �PROJECTCOMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL RETURN �STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION RE�UIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 OwnerlContractor on site: inspector. � F � White Copyllnspector's File Canary Copy/Site Notice SEDGWICK HEATING & AIR CONDITIONING CO. TESTRE�CORD JOBNO. � � 1408 NORTHLAND DRIVE,SUITE 310 • MENDOTA HEIGHTS,MN 55120 • (952)881-9000 ADDRESS �` I J `�" ��' CITY �� OCCUPANT ��` OWNER � %r�f C L l i.' ,L L��a �'" l � SOLD BY � � INSTALLED BY MAKE ��IP�'�-%�� MODEL ��K'C%�[��(.,'� ��a.." ��' SERIAL NO. �C�l��`�C�� INPUT ! `'`i C-L='�-'' � ��l THERMOSTAT � VENT SIZE i _�/� VALVE �� '`r � TYPE OF LINER '� ��r LIMIT �'� LINER SIZE rJ LIMIT SETTING a � FILTERS: SIZE._, �!�'"� NUMBER �� (� FAN SETfING ��" - � WIRING �<<-�� --. ��E��.�� PILOT TYPE� TEST TAG / ?,✓ --- -- IGNITION MODEL LIGHTING INST.�/� �'/ PILOT TIMING � ` ��L/�� DATE TESTED PRESSURE �` � PERCENT COz `�� ,� ��C � 2_ COMPANY TESTING ��-"� / LZ�� INPUT CFH PERCENT OZ STACK TEMP. PERCENT CO v NAME OF TESTER�1�� FORM 235(REV.10/10) FORM DISTRIBUTION: WHITE COPY•JOB FILE YEI.LOW COPY-CITY �� SEDGWICK HEATING & AIR CONDITIONING CO. HEATING J06N0. 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 • (952)881-9000 TEST RECORD ADDRESS ��J �'r�UN�`I ��y� � CITY� / ��J v v OCCUPANT ' � � OWNER �✓ �'�,I�J �� t�`.il" SOLD BY �/� �-� �� INSTALLED BY ��L� C��/r�� 1-, ��-�-� � ,� l/ MAKE � MODEL �� r•E� �/ r � n -Z`-� -�-^� SERIAL NO.-;)� � l � � `� "'� � "' �' INPUT � �`�� THERMOSTAT VENT SIZE j J VALVE � C l"" � � TYPE OF LINER f i �✓'� LIMIT ' X� ' LINER SIZE � 7 � � f � ,� t�, � / • C__. � LIMIT SETTING / �^_` FILTERS: SIZE � NUMBER FAN SETTING �--''M�- � WIRING s��v r��`� `� PILOT TYPE '-�` ��,L�1 �� TEST TAG ` IGNITION MODEL ��'�'d x;� LIGHTING INST. � �� / PILOT TIMING �^�� '��` �� f� � � ;i� , � DATE TESTED �-'� `> ��L�1/• `- �-�•/ , PRESSURE - � PERCENT CO2 �; �" �� COMPANYTESTING _ �-��'"' �]�� INPUT CFH �� PERCENT OZ /` ^ - > STACK TEMP. � "�' � PERCENT CO ��'�� NAME OF TESTER � - "�`��-�'� FORM 235(REV.11/89) FORM DISTRIBUTION: WHITE COPY-JOB FILE YELLOW COPY-CITY �� 1 SEDGWICK HEATING & AIR CONDITIONING CO. HEATING JOB NO. � � 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS,MN 55420 • (952)881-9000 TEST RECORD b L � � ADDRESS �� CITY � OCCUPANT OWNER a l`� SOLD BY S[�'��"�� /l- INSTALLED BY -�'�`"�-- `� - MAKE ��, MODEL r� ��![/ L/1 �I C�!� ��! �✓ SERIAL NO. � ! � / /'� � � / `� -� � � O� S� INPUT y,� THERMOSTAT VENT SIZE VALVE /Y �7�-%C � ��' �� TYPE OF LINER �� .,� �r� LIMIT �� _✓'� LINER SIZE LIMIT SETTING � `� �� FILTERS: SIZE�''+�' C� NUMBER FAN SETTING �'�� `"' WIRING � "� '�-''ry�J � PILOT TYPE ��/��-^� ��`�� / TEST TA� IGNITION MODEL �� LIGHTING INST.�� PILOT TIMING ., ��,�0�1-'� DATE TESTED �� l O � PRESSURE�J � w� � ' PERCENTCO2 � /� �� r� COMPANY TESTING S�� L��J ' �� INPUT CFH • - __* PERCENT Oz � � STACK TEMP. � '�� PERCENT CO �*�/'-� NAME OF TESTER �' _ ` FORM 235(REV.11/89) FORM DISTRIBUTION: WHITE COPY-JOB FILE YELLOW COPY-CITY � SEDGWICK HEATING & AIR CONDITIONING CO. � HEATING JOB NO. �� 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS,MN 5542 �• (952)881-9000 TEST RECORD ' �� ADDRESS �� C� �� CITY �/ OCCUPANT OWNER (' `� r` SOLD BY —�C"' c i✓' C/, J�'�E' INSTALLED BY � ��C l /�� , A) � i / MAKE /�-'_� MODEL `, L� � � ��`� �//`�� SERIAL NO. ��/ `� ��l J '��A� � INPUT `- ��./ � THERMOSTAT VENT SIZE �l ��// VALVE �Q�`��= � '�L L� TYPE OF LINEA ,�r�� ,/ L�' ��l LIMIT �'r•� LINER SIZE LIMITSETTING /�� FILTERS: SIZE ��`�Xv`��'"'',� NUMBER FAN SETTING �'�'�� ! ' WIRING 'y�' '�' L'��j^-' PILOT TYPE C,/�'"`� �� I TEST TAG ✓ LE s�./�,C>� 1/ IGNITION MODEL LIGHTING INST. PILOT TIMING �� 5�l/n� � ,�'_ � , � 7 ---> •� �l� DATE TESTED PRESSURE `- 1'~ �'< <-.,PERCENT CO2 ''� ,y� U COMPANYTESTING "��r�"'/ �' �"� �� INPUT CFH �� PERCENT OZ � �� STACK TEMR � �� PERCENT CO � `�`� � � NAME OF TESTER �- � FORM 235(REV.11/69) FORM DISTRIBUTION: WHITE COPY-JOB FILE YELLOW COPY-CITY