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�, CITY OF ORONO PERMIT NO.: 2010-00627
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 07/27/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 2103 SUGARWOOD DR
PI lv : 34-118-23-21-0018
LEGAL DESC : SUGAR WOODS
: LOT 004 BLOCK 003
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : HEATING SYSTEMS
VALUATION : $ 3,200.00
NOTE: GARAGE IN FLOOR HEATING
APPLICANT MECHANICAL 50.00
B& D PLUMBING&HEATING INC. STATE SURCHARGE MECN(VALUATION) 5.00
4145 MACKENZIE CT NE TOTAL 55.00
ST MICHAEL, MN 55376-
(763)497-2290
OWNER
WINKEY, TRAVIS&LISA
2103 SUGARWOOD DR
LONG LAKE,MN 55356
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 after work has commenced.
The applicant is re onsible for ass ng all required inspections are
requested in c mance with th tate Building Code.This permit may be
revoked a fime for due ca �
� � � ����'1 � � �`�"� � i ��7 / /U ���Y� l l
A cant Permitee Signature Date Issued By Sig ure Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER T N DESCRIBED ABOV
� FOR CTI'Y USE ONLY
�,;���, City of Orono
P.O.Box 66 Date Received: Peimit#
!� �, 2750 Kelley Parkway
t!,� �''�'• ►,� Cryatal Bay,MN 55323 Approved By: Amount S:
�. '��� �,�.����i� (952)249-4600
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CITY OF ORONO-MECHANICAL PERMIT
(All Commercial pc,mtits must be approved by the Building�cial or Inspector and/or Fue 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. PERNIITS ARE NOT
VALID IJN"TIL YOU RECEIVE A PERMIT. WORK MIJST NOT BEGIN UNTIL THE
PERMTT CARD IS POSTED ON THE JOB SITE.
3. Mechanical Desi�ns—Complete calculations,details and specifications are required for each
heating,ventilation,humidification-dehumidification,and air conditioning installation including
heat loss/heat gain calculafion,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 peimit 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 )
QQ Residential �Commercial(Approval Required)
❑New 0✓ Additional ❑Repairs Q Replace
Job Site/Owner Information:
Site Address: 2103 Sugar Woods Drive
Owner: �isa Winkey Mailing Address:
Ci : Long Lake Zi
ty p:
Home Phone: Alternate Phone:
Contractor Information:
ContraCtor: B&D Plumbing And Heating Contact Person: Hollis Larson
Address: 4145 MacKenzie Court State Bond#: 3016-MB
City: St.michaei Zip: 55376 Expirahon Date: 07/01/11
Phone: (763)497-2290 Alternate Phone:
❑ Insurance-Current:
1
, MECHANICAL SYSTEMS BEING IN5TALLED
Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS THIS GEOTHERMAL? ❑Yes 0 No
HEATING SYSTEMS
Quantity: � l��i t�r9iat %�t/ i/D�'n /�Cf1'Ti2��j
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
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 E�chaust duct recirculating cfm
�❑ No. Bath Exhaust(must have duct outside) cfm
No. Other Fans: Locations cfin
FiTEL STORAGE (Must be approved by Fire MarshaU ifproposing to abandon tank in place.)
❑ Installation a Removal
Fuel Oil: gallons ❑ Underground �Inside �Outside
LP Gas: gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill ❑ Other/List What&Where:
2
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PERMIT FEE CALCULATION(S)
BASED OFF -2002 STATE STATUE
❑ Yes,this section applies
The replacement of a Residential fixture or annliance 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 appiiance:and
3. Is unproved,installed or replaced by the homeowner or licensed contractor.
Skip ne�section,if this applies; Cost of Permit $ 15.00
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)
� �
� �c�
x.0125 $
(contract price) (minimum 550.00)
2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50)
x.0005 $
(contract price) (minimum S .50)
3. POSTAGE&IIANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
■ * CONTRACT PRICE or JOB COST means the actual or estimated doliar 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 fiunished by
the owner,tenant or any other party,the reasonable market value of such items must be added to the
estnnated cost or contract price for peimit 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 Departrnent at(952)249-4600 for the pnce.
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 or � ces of the Ci -and the regulations of the State of
Minnesota, and certifies that all s nts made on � application are complete, true and
correct.
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Applicant's Signature: � Date:
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