HomeMy WebLinkAbout2002-P05623 - addn/remodel/repair . � t
F R N PERMIT
CITY O � � � Permit Number:
2750 Kelley Parkway - PO Box 66 P05623
Crystal Bay, Minnesota 55323 Pel'C111t Type: Addition/Remodel/Repair
(952) 249-4600 Date Issued: ioi9i2oo2
SITE ADDRESS: 560 Sussex Cir
LONG LAKE,MN 55356
P I D: 04-117-23-32-0020
DESCRIPTION: UBC Occupancy R3
Construction Type VN
Proposed Use: Residential
Buildin Census Code 434
Pernut Class: g
Pernut Type: Addition/RemodeURepair Permit Sub-type(s): Addn/RemodeURepair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: PermitFee: $ 811.75 Valuation: $ 73,600.00
State Surcharge Fee: $ 37.30
TOTAL FEE: $ 849.05
APPLICANT: Metro Builiding&Ptg Co,Inc. OWNER: 7 R&R L WHITMAS
4738 42nd Ave N 560 SUSSEX CIR
Minneapolis,MN 55422 LONG LAKE MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICI'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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� �PPLICANT PERMITEE SIGNATURE SSUED BY SIGNATURE �
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Copies: 1-File(SiQnitures Required), 1-Aonlicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
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. � ' Total Fee: $ ��,`��( ' L;� Date Received: �-=(- 1�-� ��
Entered By: Pernut#: Q ,5����
CITY OF ORONO - BUILDING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ��� ..�ri ,5.��,� G ����/Q ZIP:
NANIE OF OWNER:��e3���' �•✓'�� ��`'_�/,tS PHONE: (home)
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MAILING ADDRESS �.5�-� C�^ CITY: W�c �, , ZIP:_�T���
CONTRACTOR: �.PZJ v ,��T t`/oP� tti c �'� PHONE: ^��, "� ��''l'/� 7T
CONTACT PERSON: .,d7"a� ,����T-7 MOBILE/PAGER: � /a- $��j-� $�$
MAILINGADDRESS: �7�� ��,�/ ��'.,� CITY: 111�,�- ZIP: ��Z
STATE LICENSE: #
ARC�-IITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
�'��`����,�Move Remodel/Alteration Land Alteration
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PROPOSED WORK(describe in detai�: ff�,�T�r ���r..� ,�j,��, ��„� �
{--. �,
STORIES: _� SQ. FEET OF EACH FLOOR: {� ���
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $ "]3,bac�"�--
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the City and with
the State Building Code; that I understand this is not a permit and work is not to start without a
permit; and that the work will be in a dance with the approved plan.
,
APPLICANT'S SIGNAT ' �'""� DATE: �'"' J� D,Z
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NOTE! Parade o H m e � equire separate permit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
5
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Sec.13.04 RIGHTS OF S[JBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
S�bd.2. Information required to be given individual. An individual asked to supply private or confidendal data concerning himself
shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,polidcal subdivision,or statewide
system;(b)whether he may refuse or is IegaUy required to supply the requested data;(c)any known consequence arising from his supplying or
refusing to supply private or confidential data;az�(d)the identiry of other persons or enaties authorized by state or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply investigative data,pursuant to secdon 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revenue mav olace d�e notice rewired under this subdivision in the individual income tax or orocertv tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the
subject of stored data on individuals,and whether it is classified as public,private or confidendal. Upon his further request,an individual who
is the subject of stoced private or�blic data on ic�ividuals shall be shown the data without any charge to him and,if he desires,shall be informed
of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be
disclosed to hicn for six months thereafter unless a dispute or action pursuant to this section is pending or addidonal data on the individual has been
copected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies.
The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days
of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with
the request within that time,he shall so infornt the i�ividual,and may have an addidonal five days within which to comply with the request,
exciuding Saturdays,Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contast the accuracy or completeness of public or
private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing die nature of the
disagreement. The responsible authority shall within 30 days either: (a)correct the data fourM to be inaccurate or incomplete and attempt to notify
past recipientt of inaccurdte or incomplete data,including recipients named by the ic�ividual;or(b)nodfy the i�ividual that he believes the data
to be correct. Data in dispute shall be disclosed only if the i�ividual's statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the admiaisorative procedure act relating
to contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your
request for a permit or license from the �iry of Orono or any of its departments may require you to furnish certain
private or confidential information.
You are notified that:
i. The information you fumish will be used to determine your qualification for the permit or license
requested.
2. You may refuse to supply data, but refusal may require that the City deny the permit or license.
3. The information may be shared with other local, state or federal agencies to the eztent necessary to
process the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5. You have certain rights under M.S. 13.04(available upon request)to review private data on yourself.
6. Your full name is required to process this application or permit.
First Middle Last
Address .
Ciry State Zip P6one
I unde d m ights as stated above.
6
. . �
,. - CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: S�� s�ss.a� -
PID:
DESCRIPTION OF WORK: �,t��r�,v6 ,G'I�,v�a6 e ��Q��2
ZONING REVIEW BY: N' !q DATE APPROVED:
BUII.DING REVIEW BY: _ . DATE APPROVED: �o- 9•oL
FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes � No
PLAN REVIEW Yes No v SEWER COrfNECTTON
STATE SURCHARGE Yes �/ No WATER CONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: N'o C����
Fire Department: Post Office: School District:
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front(Lake): Right Side:
Rear(Street): Left Side:
Adjacent Structures: We land:
Building Height: Def. Hgt. Pe Hgt.
Lot Coverage:
Grading: Staff Approval Date: Council Approval Date:
Septic: Staff Approval Date: B :
Zoning File: # Resolution: # Resolution Date:
Shoreland District:
Avg. Setback: Bluff Setback: L.ot Coverage:
Existing Proposed
Hazdcover: 0-75'
75-250'
250-500'
500-1000'
Hudcover Vaziance Required: Yes No Date of Council Approval:
REMARI�S(in house):
7
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BUILDING REVIEW CHECK LIST
UBC: �" ?j CONSTRUCTION TYPE: Yi'✓
Sq Footage $Per Sq Ftg
Basement x =
lst Floor x =
2nd Floor x =
Garage z =
R =
TOTAL
Estimated Construction Value: $ �3,(o dc� �-
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hazdcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
�Framing Fireplace Lawn Irtigation
p� Insulation (Masonry) Other
K Wall Board (Mfg.) Well(State Pemut)
_�Final Grading/Filling Electrical(State Permit)
Other
REMARKS(IN HOUSE): �
REV�W BY OTHERS: DATE:
Access: Existing New
Access Approval: Date By:
REMARKS (TO BE NOTED ON PERMIT�:
8
DATE TIM
CITY OF ORONO CALLED IN
INSPECTION NOTICE '� ���,'7SCHEDULED /v-�- DZ
PERMIT NO. !�� COMPLETED
ADDRESS 56� S�SSex
OWNER CONTR.
TELEPHONE NO.
� DESCRIPTION L«�n/`�y p/1»�A-tc Q����/Z
� Ot FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 RAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TFEE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W O CORRECT WORK 8�PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 O CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
O STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTIONRE�UIRED.CALLTOARRANGEACCESS.
Ca11 for the next insp ction 24 hours in advance. (g52) 249-4600
Owner/Contractor on si
Inspector. -�
White Copy/lnspector's File Canary CopylSite Nofice
4 CITY OF ORONO * Z 0 1 6 - 0 1 S 4 3 *
2750 KELLEY PARKWAY DATE ISSUED: 12/15/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 560 SUSSEX CIR
PIN : 04-117-23-32-0020
LEGAL DESC : FOX BEND
: LOT 003 BLOCK 002
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : HEATING SYSTEMS
VALUATION : $ 2,500.00
NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION.
(1)DAIKIN NATURAL GAS FURNACE
APPLICANT MECHANICAL 50.00
CENTERPOINT ENERGY STATE SURCHARGE MECH(VALUATION) 1.25
6161 GOLDEN VALLEY RD MAIL-IN FEE 2.00
BUILDING A TOTAL 53.25
GOLDEN VALLEY, MN 55422- Payment(s)
(763)512-2765 CHECK 20709 53.25
Minnesota State License#:mech-M6003503
OWNER
WHITMAS,JAMES& RENATE
560 SUSSEX CIR
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which Ihis 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 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.
d �. �� � ► 1- I
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Applicant Permitee Signature Date Issued B ignature Date
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Ty RECC' � FOR CITY USE ONLY
Ci of Orono c
���0 P.O.Box 66 Date Received; Permit#
2750 Kelley Parkway
Crystal Bay,MN 55323 O�� �5� �proved By::" Amount$:
y � Phone(952)249-4600 Fax 9( 52)249�-4616
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`� ��.�' CITY OF ORONO'10PL�CHANICAL PERMIT
`�kFSH� (All Commercial permits must be approved by the Building Official or Inspector and/or Fire Mazshall)
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 UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical Designs—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 fortn 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 Al1 That A 1
�Residential ❑Commercial(Approval Required) [Backflow Device: ❑ AVB ❑PVB]
❑New ❑Additional ❑Repairs ❑Replace
Job`Site/Owner Information:
Site Address: 560 SUSSEX CIRCLE
Owner: �AMES WHITMAS Mailing Address: 560 SUSSEX CI
City: ORONO Zip; 55356
Home Phone: 612-599-5697 Alternate Phone:
Contractor Informatiori:
COritPaCtOT': CENTERPOINT ENERGY COritaCt P0I'SOri: JOANN ZINKEN
AC�C�I'eSS: 6161 GOLDEN VALLEY RD,BLDG A State BOriCl#: MB003503
C1Ty: GOLDEN VALLEY Zlp: MN Expiration Date: osi2oi2o�s
PllOrie: 763-512-2765 Alternate Phone:
OLD REPUBLIC INSURANCE CO.
WORKERS COMP&EMPLOYERS LIABILITY
� II1SUr�lI1Ce—CU1Tellt: POUCY#WLRCC48597075
017
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Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS THIS GEOTHERMAL? ❑ Yes �No
HEATING SYSTEMS
QuantiTy: �
Make: DAIKIN
Model: DM80HS0803BX
Fuel: NATURAL GAS
Flue Size:
Input BTUs: 80,000
Output BTUs: 64,000
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/Masonry
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 What&Where:
2
� . � .
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00)
2500.00 x.0125$ 50.00
(contract price) (minimum$50.00)
2. STATE SURCHARGE
2500.00 x.0005 $ 1_25
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 53.25
■ * 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 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: 12/07/16
3
CenterPoint.
House heatin test record RECEI� Energy
D�C 1 5 2016
Owner�rr�e� (�,�y�-)�u� Controls ,�o��O nORONO
Address A t Thermostat` at lu Vent Size "
S� Stats� Civ P �eMna.ra� P 9 �
—/r �
���Y (,tOhd l/alve W� Kind of liner/size � ,� (JCn
Heat loss Date htg.inst Limit Fj Draft hood��ptRegulator
Soldbv CenterPoint Energy Limitsetting l(� Filters:Size i� �J(�jNumber `
Installed bv CenterPoint Eneray Fan setting �M pp� Chimney locations: Inside Q Outside
Electricalwork CenterPoint Ener _ Pilottype /�/� Chimneyconstruction ����
Heat type FA Q Space heater Pilot make "'— Wiring Test tag
Gas line by (�j'�E Pilot model `� Lighting Inst Date tested/ar'7��
Unitheater Other Pilot timing '"' Companv testinQ CenterPoint Enerqy
Gas desi n Pressure:Hi fire/Lo fire � ,�� /, � Tester's name M�p'�Q,/� 3��
9
Make Model Percent COz �,cJ ��
�GiI �1'� �f��
Serial no.
�6�����? Input CFH g�,� Percent Oz�� �,t�
Input �0 � Stacktemp,�fjj 3�}PercenfCO �����
T'
CNP 235(11-2008)
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DA TIME
CITY OF ORONO CALLED IN /�-o��/.� �
IH$PECTION N E SCHEDULED ��' � ���? �`�' �`
PERMR NO. ^�� COMPLETED `
ADDRESS v �J W l (�C..�G�
p�WNER h ELEPHONE NO�-s � ��� /
CONTRACTOR
� DESCRIPTION ��� ��
t�y ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/F�LLING
Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
� ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
� ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
v ❑ DEMO-SITE ❑ SEPTIC INSTALL
? dwN�1�RRACTOR TO MEET YOU:_YES_NO
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W ❑WORK SATISFACTORY:PROCEED O PROJECT COMPLEfE
� ❑OORRECT WORK 3 PROCEED O ISSUE CEFi'TIFICATE OF OCCUPANCY
O ❑CpqR�T Wpql(,CALL FOR REtNSPECTION TEMPORARY
V BEFORE CONERIND PERMANENT
❑CORRECT UNSAFE COND1710N WRHIN H��• ❑p►{pT0 TAKEN
INSPECTOR WlLL RETURN
❑$'TQp pF�ER P08TED.CALL INSPECTOR ��TATION ISSUED
�INSPECTION REQl11RED.CALL TO ARRAN(iE ACCESS.
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csa ta a�e next�specaon 2a nours in sanar�oe. (952) 249-4600
on si�e:
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WMa CoplrMs��'ss FlN C�mry CoPYl81N Notics
� � � �D�T,E�� � TIME �
CfTY OF ORONO CALLED IN _��-�1--�
INSPECTION NOTICE SCHEDULED ���� ��
PERMIT NO. � - 1 COMPLETED �
ADDRESS J� �LCS C�-
OWNE� EL PHONE NO. �S o7- Y�-�'j-S 77�
CONTRACTOR
'' DESCRIPTION � /��'�
t�y ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
�O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
v �INAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
r ❑ DEMO-SITE ❑ SEPTIC INSTALL
2 OWNERlCONTRACTOR TO MEET YW:_YES_NO
� COMMENT5:
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� ❑WORKSATISFACTORY:PROCEED ROJECT COMPLEfE
W ❑OORRECT WORK 3 PROCEED ❑ISSUE CERTIFlCATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COWERIN(i PERMANENT
❑CORRECT UNSAFE CONDITION WRHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑INSPECTION REWIRED.CALL TO ARRANGE ACCESS.
Ca8 for the next inspection 24 hours in advance. (952) 249-4600
OwnerlContractor on site:
Inspector: ` ,--=_• �!.�
White Ca6YAnspecto�'s File Canary CoPYfSite Notks
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� CITY OF ORONO * 2 0 1 6 - 0 0 8 5 1 *
2750 KELLEY PARKWAY DATE ISSUED: 07/20/2016
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 560 SUSSEX CIR
PIN : 04-117-23-32-0020
LEGAL DESC : FOX BEND
: LOT 003 BLOCK 002
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : COOLING SYSTEMS
VALUATION : $ 3,200.00
NOTE: REPLACE A/C ,
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 1.60
AIR MECHANICAL,INC. MAIL-IN FEE 2.00
16411 ABERDEEN ST NE
HAM LAKE,MN 55304 TOTAL 53.60
(763)4347747 Payment(s)
Minnesota State License#:mech-MB005122 CHECK 048067 53.60
OWNER
WHITMAS,JAMES&RENATE
560 SUSSEX CIR
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 Ciry approvals,and the
State Building Code. This permit is for only the work described and dces
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 nu►I 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 due cause.
�
ti°-1,� 7 �02�� !�o
Applicant Permi ee Signature Date Issued B ignature Date
�3-D� ��O RECEIVED
q OR TY USE ONLY
City of Oror�U� L.� ����� �1�� �O� � �g J'�'/
�O�O P.O.Box 66 Date Rece� Permit#
2750 Kelley Park,�w,a�}'
Crystal Bay,l�'��3�� Approved By: Amount$:
Phone(9�2)249-4600 Fax(952)249-4616
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`� �.�' CITY OF ORONO-MECHANICAL PERMIT
!�'�fSH�� (All Commercial 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 Desi�ns—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) [Backflow Device: ❑ AVB ❑PVB]
❑ New ❑ Additional ❑Repairs ,�Replace
Job Site/Owner Information:
Site Address: �() SU.���C. �it 1'
Owne��,�"Yl f S ��P.C1��P��/���►1"IGI�SMailing Address: ��I�D CSU�C?° �.�►�'
City: �1"D110 Zip: ��5�0
Home Phone:�Q12-.�'rl� 5�� Alternate Phone:
Contractor Information:
Contractor: I�i✓ M�G�G�,t1� ('ua Contact Person: �G1,f1SS -�t'D(',�
Address: I�p4t I Ab�P.rD�P� �n St I�1PJ State Bond#: (v� P�D()�1'Jy
City: �'1(�,YY1 LrCt-K.�i Zip�3D�.}- Expiration Date: v,� � � g
Phone: 1103 '-f��T1'-I�1 Alternate Phone: 1�3 7�-r-ip �3�lPg
� Insurance-Current:
1
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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: �,(1�
Model: � �3��f���-
Tons: �
f-I.Power
FIREPLACES
❑ Gas Factory Fireplace Brand Name:
❑ Wood Burning Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Masonry
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 What&Where:
2
� PERMIT FEE CALCULATIONS �
1. CONTRACT PRICE * is 1.25°/o of contract price with a(Minimum Fee of$50.00)
��320� � Dn X.o125 $ 5� ���
(contract price) (minimum$50.00)
2. STATE SURCHARGE ��,� n� �u x.0005 $ I • �.Q D
L—ll
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERM[T FEE(Add Lines 1-3 Above) $ 53 �lp�
■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged far 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.
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 state ade on this application are complete,triie and correct.
Applicant's Signature: Date: ,'�y'���
3
�
�� C/� DATE TIME
CITY OF OAONO cnLLED IN
INSPECTION N TICE Q SCHEDULED �
PERMR NO. '� �O�I COMPLETED
ADDRESS ' �� , -�-��-� ��
OWNER TELEPHONE NO. �'�� ����,4�
CONTRACTOR ,//'� /���
� DESCRIPTION T / /�a /
� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL � /�
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILL G
Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ $ITE INSPECTION
Q ❑ FRAMING �ECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
41 ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
� ❑ DEMO-SITE ❑^S�TIC INSTALL
2 ONfNERlCOi�fTRACTOR TO MEET YiOU:J�YES_NO
y COMMENTS: ��^
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� ❑WORKSATISFACTORY:PFtOCEED �ROJECT COMPLEfE
W ❑CORRECT 1MORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK�LL FOR REtNSPECTION TEMPORARY
V BEFORECOA/ERING PERMANENT
❑CORRECT UNSAFE CONDITWN WITHIN HOURS. ❑pH0T0 TAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
OwnerlContractor on site• •
Inspector: `
White CopyMnspector's Flle Cenary CopylShe Notke