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CITY OF ORONO PERMIT NO.: 2011-01403
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUEn: i U04/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 1280 SPRUCE PL
PIN : 08-117-23-32-0027
LEGAL DESC : N/A
: LOT MB BLOCK O10
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL-MULTIPLE
VALUATION : $ 7,000.00
NOTE: (1)JBC HEATING SYSTEM
SL-20-115-NATURAL GAS - `
_.. .____._ ... .._ ...,.
_ _. _ _
3"PVC FLUE " -
115,000 INPUT , �
110.400 OUTPUT - ' � `
.. . ._ �
APPLICANT MECHANICAL 87.50
UMR GEOTHERMAL - � � ' " "- � STATE SURCHARGE MECH(VALUATION) 3.50
5115 INDUSTRIAL STREET
MAPLE PLAIN,MN 55359 _ TOTAL 91.00
(763)479-6325
OWNER
GUSTAFSON,GREGORY&JEANNE _._,____..__. ._ _ .
1280 SPRUCE PL _ __....._ -•---_____�._—______ _.. . _
MOUND,MN 55364 , ...
..._ ....--
_._ _.... ..
,
AGREEMENT AND SWORN STATEMEI�FT-
The work for which this permit is issued shall be performed according to . ___ . .,.- ..- • -•
the approved plans and specifications,applicable City appcavals,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. All provisions of laws and ordinances governing this typa of work -�J,.. � -�
shall be compied with whether or not specified herein.This permit will ,. _ . _ .... .
expire and become null and void if construction authorized is not . . � '
commenced withi�-� days of the date nf'issuance,or if construction is
suspended for a perio�of 180 day�afany � �after work has commenced. ,_.._._-•. '" " '� ��
The appljeant is resp"odsible f9�'assuri a�,required inspections ac'�'
reyue�C'ed in confp ance�yrfh the S mlding Code.This permit may be
rev,d�ced at any,tfine for dy�caus ;'
� i .. _ .. -
�,, .�., i� � y � � �i � �
� Applicaoi�P"ermitee Signature Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
. .,.,,
� �� �rr usE or�.�t
p City of Orono ��
0�' �Q P.o.saX 66 ��e���a:�� � ����g��#�c��/1� ��
� 2750 Kelley Parkway �j �ty,
��►?���'"� Crystal Bay,MN 55323 Acpp�rved&y: �Amaut�t$: I� �/u
�� Phone(952)249-4600 Fax(952)249-4616
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CITY OF ORONO—MECHANICAL PERMIT
(All Commercial permits must be approved by the Building Official or[nspector and/or Fire Marshall)
GENERAL INF�RMAT�ON
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. PERIWTS 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 Mechanicai 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.
`T�PE OF PER�VIIT
Chec�c Atl'I'��at�1 �
0 Residential ❑Commercial(Approval Required)
❑New 0■ Additional ❑Repairs ❑Replace
�ah S�te/ETwner�nfo�a�ian:
s�te aaaress: 1280 Spruce Place
Gre Gustafson 128o Spruce Place
Owner: g Mailing Address:
c,�,: Orono Z;p. 55364
Home Phone: Alternate Phone:
Cantractor Infortnation:
UMR Geothermal, �n�. Sara Pippel
Contractor: Contact Person:
Address: 5115 Industrial Street State Bond#: 92939H775
55359
City: N Zip: Expiration Date:
Phone: (763) 479-6325 Alternate Phone:
❑ Insurance—Current: 8/���2
1
- - �
l�iote: All Geothermal Systems will now require a Site Plan&Review by our Building Official.
[S THIS GEOTHERMAL? Yes �o
HEATING SYSTEMS
Quantity: �
Make: ���
Model: 5 L ���"(�s
Fuel: (�} . (sa-�_
Flue Size: 3'' i�L
Input BTUs: �j S� C7�7
Output BTUs: (�0 ���
CFM: —"
COOLING SYSTEMS
Quantity:
Make:
Model:
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) cfm
No. Other Fans: Locations cfm
FUEL ST GE (Must be aPproved by Fire Marshall if proposing to abandon tank in plac�)
[nstallation � Removal
Fuel Oil: gallons ❑ Underground ❑ Inside ❑Outside
LP Gas: gallons
Other:
GAS LINE ONLY
Outdoor Grill � Other/List What&Where:
2
� 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;excludine the cost of the fiacture or appliance:and
3. [s improved,installed or replaced by the homeowner or licensed contractor.
Skip neact section,if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $
If above does not apply;follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
,C;�'� xA125$ ��',��
contract price) (minimum$50.00)
2. STATE SURCHARGE **Add the State Bidg Code Div.Surcharge(Mioimum Fee of 55.00)
�-,D D�•C7� x.0005 $ �; ��j
(contract price) (minimum$5.00)
3. POSTAGE&HANDLING(Only on Mail-[n Applications) $ ._�2:�Q"�
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 9( •�D
■ * 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 times the Contract Price or a minimum of$5.00.
The undersigned hereby applies t e ity for issu Mechanical Permit, agrees to do all
work in strict accordance wit he o dinances the City and the regulations of the State of
Minnesota, and certifies th all s tement made on thi application are complete, true and
correct.
Applicant's Signature: Date: ��`/ '( /
�� . ..` 3
_ . 5 �F