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Home My WebLink About2011-01286 - gas fireplace CITY OF ORONO PERMIT NO.: 2011-01286 2750 KELLEY PARKWAY ORONO,MN 55356- DATE ISSUED: 10/20/2011 952 249-4600 FAX: 952 249-4616 ADDRESS 2985 WATERTOWN RD PIN 04-117-23-21-0001 LEGAL DESC AUDITOR'S SUBD.NO.230 LOT 006 BLOCK 000 PERMIT TYPE MECHANICAL(>$500) PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE FIREPLACE-GAS VALUATION $ 4,765.00 NOTE: 1 GAS FP APPLICANT MECHANICAL 59.56 FIRESIDE HEARTH&HOME STATE SURCHARGE MECH(VALUATION) 2.38 2700 FAIRVIEW AVE ROSEVILLE,MN 55113 MAIL-IN FEE 2.00 (651)633-2561 MISC FEE 0.00 Minnesota State License#:20512060 TOTAL 63.94 OWNER GHERARDI,RICHARD&LORI 1010 WILLOW VIEW LANE 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 responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any �time �for duce crause. Applicant Permitee Signature Date Issued—By ftnature ate SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A OV FOR CrrY USE ONLY Q0 City of Orono P.O.Box 66 Date Received: Permit# 2750 Kelley Parkway Crystal Bay,MN 55323 Approved By: Amount$: �i ' Phone(952)249-4600 Fax(952)249-4616 `� CITY OF ORONO—MECHANICAL PERMIT (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 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 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. (2448 hour notice required) 7. House Heating Test Record must be submitted before final. TYPE OF PERMIT Check All That Apply) IffResidential ❑Commercial(Approval Required) ❑New ❑Additional ❑Repairs ❑Replace Job Site/Owner Information: Site Address: Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: 771 Contractor: / xaia4�/j Contact Person: Address: 2780 Awly tlicv-ah t Al State Bond#: 097 I 01170 City: /&"yC& Zip:5:3 Expiration Date: ? Zd/Z Phone: �'i'1- 3�'lD�/y Alternate Phone: ❑ Insurance—Current: 1 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: Model: Tons: H.Power FIREPLACES Gas Factory Fireplace Brand Name: ly- ❑ 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) cfm ❑ 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 ❑ 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;excluding 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 $ If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) tfi1 7&4�o x.0125$,�e T( J (contract price) (minimum$50.00) 2. STATE SURCHARGE 440/,I,7`S OD x.0005 $�2,39 �1 (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 6 3, / _ ■ * 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: a„ 3 11/14/2011 14:23 952-955-5071 BURNS EXCAVATING PAGE 02 N E 90 T A Minnesota Department of Health Well Management Section P.O. Box 64975,St.Paul,Minnesota 55164-0975 651/201-4600 or 800/383-9808 Certification of Buried Sewer Construction and Testing This form must be completed axed submitted to the Minnesota Department of Heals WH)for installation l located d a buried sewer located 20 to 50 feet from a water-supply well, or the installation of PP Y 20 to 50 feet from a buried sewer.NOTE: A 50-foot minimum separation must be maintained between a water-supply well and a buried collector or municipal sewer,an unapproved sewer, or a buried sewer serving a facility handling infectious or pathological waste. Owner of 1?ropaV Wham Sewer is Located(please print) PIC444[ZeJ Street Address,City.7.iP for PropertY Whore Sewer's Located Zq$S' !A- 'O Lv1Ll by�cj o p-bx1b, M AJ. 5 57r County Name 'tbwnship No. Range No. Section No. Practioa t�4 �4 1/4 t,j�i 6 fu (mtr✓ddlyyyy) person(s)Preswt to witness Testing Well Information Provide Minnesota Well and Boring Number(s) or,if unavailable, Ovide the followinginformation for each well located within 50 feet of the buried sewer, well Address Well well Year of Well Contractor Well No./Aescridon ]Depth Diatacter Construction Co an Nome if diffemnt from above Variance Information Was a variance issued by the MDH for this sewer or well installation? ❑Yes Jallo If yes,please provide the variance tracking number: TN Sewer Materials ❑ ABS (ASTM D2661) [] ABS (ASTM D2751) ❑ ABS (ASTM F628) gPVC(ASTM D2665) ❑ PVC(ASTM D3034) PVC(ASTM F789) PVC(ASTM F891.) ❑ Cast Iron- Test Methods (check one) Air Test(5 psi constant pressure for 15 minutes). Manometer Test(1-inch water column). ❑ Hydrostatic Test(for plastic pipe only). The portion of the buried sewer system tested is described as follows(please specify each segment of sewer pipe which was tested). ,rip Please draw a diagram of the sewer system on back and note the locations of any wells and the portions of the sewer system that were pressure tested. 11/14/2011 14:23 952-955-5071 BURNS EXCAVATING PAGE 03 w Buried Sewer Testing Diagram Please draw a site diagram of the sewer system and all buried sewer pipes, including those buried beneath buildings(serving floor drain[s],bathroom[sl,laundry froom,etc.).Please note the portions of the buried sewer pipes that were pressure tested, the location of the well(s), and major landmarks on the property. Lvr•� r\ (name) — o%-Gee- b ,certify that the buried sewer(s)des 'bed above is/are I, constructed of the indicated,approved sewer material meeting the requirements of the Minnesota Plumbing and has/have been successfully tested in accordance with Minnesota Code,Minnesota Rules,part 4715.0530, Rules,part 4715.2820,by the indicated method. In accordance with Minnesota Statutes, section 144.992,persons submitting false information to the Minnesota I)epartment of Health are subject to administrative penalties of up to$10,000. Nettie Title S r- t- Yti )76- Firm $t=L Add=s y?d o state zioP code City Mft T icrppe/Cerdfication Number signatureDate I HE-01488.03 origs/aowcr test[vtm.doc TvVDAT TIME V CITY OF ORONO CALLED IN /D_Zr INSPECTION NOTICE SCHEDULED 16-27-11 PERMIT NO.oZD I(—Q 12-86 COMPLETED n ADDRESS o2�8S �.t��1 /`' ' OWNER TELEPHONE NO.4212–363 l ( 35 CONTRACTOR �� >: DESCRIPTION FE W ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAWGRADING/FILLING W ElPOURED WALL ❑ MECHANICAL RI El LAKESHORE/WETLANDS h Q El FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT ❑ DEMO-SITE ❑ SEPTIC MAINT ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL OWNER/CONTRACTOR TO MEET YOU:_YES_NO COMMENTS: QC W a J O Cr O W W CC Q ti 2 W Z W CC 3 140 RK SATISFACTORY:PROCEED ElPROJECT COMPLETE CC W ❑CORRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN 11STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: f Inspector. White Copy/Inspector's File Canary Copy/Site Notice