HomeMy WebLinkAbout1992 - 004763 - mechanical 4 PERMIT
f CITY OF ORONO PERMIT TYPE: MECHANICAL
1335 Brown Rd. South • P.O. Box 66 Permit Number: 004763
Crystal Bay, Minnesota 55323 Date Issued: 10/2:0/q2
(612) 473-7357
SITE ADDRESS: r
461==0 WEST BRANCH RD
P . I . N. : 06 17-2 -33- 006
DESCRIPTION:
HTG SYSTEM
1 HEATING SYSTEMS FUEL NATURAL GAS MAKE LENNOX
MODEL G210:=1-6 y INPUT 60, 000
;_.!I Y OF ORONO
FlMal. OFFICE
1,313300000
J1JJVVV00 #
'!i 'rill i?! Ars
V/1 121.11JV1.
a V
1222200000
f!i f rill Si!
1/1 VLU aJt•
*iri'f!i!!1{5t! ''''
13)511 VVVVV YT,.
REMARKS: 111 rrxi
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FEE SUMMARY: 11'f gf"-
Ease Fee $30 . 00 MAIL IN $1_50
Surcharge 1-SO Total Fee $3.7) . 00
Subtotal $30.50
CONTRACTOR: - App? i cant• - OWNER:
SEDGW I C:K: HTG & AC Ca i _39:3190010 BAKER JOHN
8910 1 WENTWOORTH AVE _ 46R0 WEST BRANCH RD
MINNEAPOLIS MN 55420-2814 ORONO MN 55364
(612) 8R1-9000
THE UNDERSIGNED .HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS
SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF
ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT/PERMITEE SIGNATURE ISSUED BY SIGNATURE Zeta,
(C11
CITY OF ORONO
APPLICATION FOR MECHANICAL PERMIT
GENERAL INFORMATION
1. You may apply for mechanical permits by mail cp' in" 'peso ,the City
offices. Mailed-in permits are subject to the postage and -handf.ing fees
shown below.
2. Permit cards will be sent by return mail the same day the application is
received. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT
BEGIN UNTIL. THE. PERMIT CARD IS POSTED ON THE JOB SITE.
3. When any new construction or remodeling is involy ae ate building
permit must be obtained. 3 �
4. All work must be done in accordance with State Building Code requirements.
5. All work must be inspected (rough-in and final). Call 473-7357. 24-hour
notice required.
6. House Heating Test Record must be submitted before final.
INSTRUCTIONS Complete all items on this application. Compute the permit fee.
Sign and date the certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
If you have questions, call 473-7357.
WALK-IN PERMITS apply at City Offices, 1335 South Brown Road (Cty. Rd 146)
MAIL-IN PERMITS enclose fee - Mail to: P.O. Box 66, Crystal Bay, MN 55323
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Please check one: _ New Addition Repair j/ Replace
JOB SITE: 4144' 1r,.4,FeC �d�J�1 . . Zip: _
Owner' s Name: h 1 �e ' Telephone Number:
Mailing Address:.1 /r . City: en, Zip: ,s-6-13G /. ,
Contractor' s Nam- : Telephone Number: . . _
Mailing Address City: Zip:
********************************************************************************
MINIMUM FEE ( $30.00 per project)
********************************************************************************
SYSTEM. DESCRIPTION:. $15. 00 each unit
Heating Systems :
Quantity: . , , . �. .
Make: Nib.
Model:
Fuel:
Flue Size: le'
_
Input BTUs :
Output BTUs: ,
CFM:
********************************************************************************
Cooling Systems :
Quantity: _
Make:
Model: _
Tons:
H.Power:
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*WOOD BURNING EQUIPMENT $15. 00 each unit
Wood stove with flue
Wood combination or add-on unit
Factory fireplace with flue
Factor Fireplace (s) freestanding Masonry
Wood Stove (s ) franklin, other
BrandName Model No.
Mfgr's Min. , Clearances, side , rear , min. flue dia.
Total
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VENTILATION $15.00 each project
No. Kitchen Exhaust ducted recirculating cfm
No. Bath Exhaust (must be ducted outside) cfm
No. Other Fans: Locations cfm
Total
********************************************************************************
FUEL STORAGE (must be approved by fire marshal)
$30. 00 Permanent/Temporary
Fuel oil, gallons underground inside outside
LP Gas, gallons
Other Gas opening
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GAS LINE INSPECTION
High/Low Pressure $15.00
********************************************************************************
PERMIT FEE CALCULATION
1. Total of above Installations or Minimum Fee ($30.00) $ N..qrj,17t)
2 . State Surcharge. Add the State Building Code Division
Surcharge to each permit $ . 50
3. Postage and Handling on all mailed-in applications, $ 1. 50
4. TOTAL PERMIT FEE add lines 1-3 above $
The undersigned hereby applies to the City of issuance of a Mechanical Permit,
agrees to do all work in strict accordance with the ordinances of the City and
the regulations of the Minnesota State Building Code, and certifies that all
statements made on this application are complete, true and correct.
Applicant' s Signature: c7472de 143 ) !J/. 4') Date: /40/or,,,&d,
SEDG IC!<
HEATING & AIR CONDITIS::: :3 CJ.
8910 IVENTVICf':Tl1 AVE. CO.
MINNEAPOLIS, MN 55420
881-9000
SEDGWICK HEATING & AIR CONDITIONING CO. HEATING JOB NO. 7Z5 D z-
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 • (612) 881-9000 'TEST RECORD
ADDRESS 1.4 440 (2) f 5 7• Oi 4' W . CITY OeD,10
OCCUPANT `\c' !-v) }A1C OWNER Grc}(C.LSg--
SOLD BY S f pr(,J SCK— INSTALLED BY 14__t4,TL4<_
f CIT:'
�^f f/�(/D� _ (-1_-_:..Z. _-J
MAKE MODEL 1.. If - �� r I _
raj �/ l i �-
SERIAL NO. JIIJ�Z `,' 2? INPUT f t OOD
THERMOSTAT r.-''`g 7 VENT SIZE 2 it
Pv L - -
VALVE 1/41/1 TYPE OF LINER /4 MOV r1 r2 992
LIMIT 40//el14./[El- L LINER SIZE N//4 - -
LIMIT SETTING lff0 FILTERS: SIZE (Ox 2 5 NUMBER
FAN'SETTJNG 13 a WIRING
PILO TYPE EL�(-en,,i/{_ TEST TAG
IGNITION MODEL r/, /prcmF T" LIGHTING INST.
PILOT TIMING /l)S Ai(f •.-
a O% DATE TESTED \`.--I-c't-z._
PRESSURE .2,O id e-- PERCENT CO2 ` <e,
INPUT CFH IQ0 PERCENT Oz 5 rO COMPANY TESTING S£Dlt�`/i
STACK TEMP �5 PERCENT CO NAME OF TESTER
is--C) ` -- �
FORM 235(15 r 9� Q FORM DISTRIBUTION' VHITE COPY-JOB FILE YELLOW COPY-CIN •
v \_
k.-
DATE TIME
CITY OF ORONO CALLED IN I 'q C?i 1 V ie'}'
INSPECTION NOTICE SCHEDULED (� Z1!fie)jOflt
PERMIT NO. ,�jo '7 3 COMPLETED l
/
ADDRESS - L,c-' -r/(
OWNER161LALQ—)\-- CONTR.
147A—
TELEPHONE NO. OH c1Oo-
DESCRIPTION
L 01 FOOTING •' • 16 WELL TEST PUMP
ct ct 02 FRAMING 18 EXCAV/GRADING/FILLING
y 03 INSULATION 24125 rva•. ;.- , (REPLACE 19 LAKESHOREIWETLANDS
04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
4INAL 13 METER SET/TURN ON 17 SITE INSPECTION
DEMO—SITE 14 SEWER HOOK-UP 06 PROGRESS
J 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
W 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 10 PLUMBING FINAL 23 SEPTIC FINAL
Q OWNER/CONTRACTOR TO MEET YOU:_YES NO
o COMMENTS:
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W
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0
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0
W
CC
W
W
CC
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WORK SATISFACTORY:PROCEED PROJECT COMPLETE
CC W
❑CORRECT WORK&PROCEED ISSUE CERTIFICATE OF OCCUPANCY
• El CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
C3 BEFORE COVERING PERMANENT
El CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑ CITATION ISSUED
El INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.473-7357
Owner/ConIs r site:
Inspector.
White Copy/Inspector' File Canary Copy/Site Notice