HomeMy WebLinkAbout2009 - 00235 - gas line only CITY OF ORONO PERMIT NO.: 2009-00235
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 05/15/2009
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2740 WHITE OAK CIR
PIN : 04-117-23-42-0019
LEGAL DESC : REG.LAND SURVEY NO. 1447
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : GAS LINE ONLY
NOTE: GAS LINE-MOVE COOKTOP GAS AND CONNECT TO NEW COOKTOP
APPLICANT MECHANICAL(<$500) 15.00
WELTER&BAYLOCK INC. STATE SURCHARGE MECH(<$500) 0.50
2014 4TH AVE. SW#3 TOTAL 15.50
NEW PRAGUE,MN 56071
(952)882-8681
Minnesota State License#: 003744PM
OWNER
BERRELL,ROBERT&KAREN
2740 WHITE OAK CIR
LONG LAKE,MN 55356
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in confo - i� the State Building Code.This permit may be
revo 's at an ti fo . e.
Is/k. 05"; .2 _
App 'cant P- -e ignature Date Issued By ' nature / Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED i, E.
FOR CITY USE ONLY
•
• �� City of Orono
Ow
P.O.Box 66 Date Received: Permit#
a 2750 Kelley Parkway
. !� Crystal Bay,MN 55323 Approved By: Amount$:
' ° (952)249-4600
O'y
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.
(24-48 hour notice required)
7. House Heating Test Record must be submitted before final.
TYPE OF PERMIT
(Check All That Apply)
Rsidential ❑ Commercial(Approval Required)
❑ New Additional ❑Repairs ❑ Replace
Job Site/Owner Information:
Site Address: (27-7O L1 .^l2 a(,,
Owner:. Oh Fe-we/ Mailin g Address: g '/D (,�`il1 f e cad
City: P fbi4 v Zip: S -�
Home Phone: /)5c2.c2 '/ ��_ ' �' Alternate Phone: 9502 973- gg 7 7
Contractor Information:
Contractor: b-26/76(47,7 4 ,.rc Contact Person: Skt' Z s
Address: (790/ 7 1&- . /.3 State Bond#:
City: Nom' Y�f ja-t~ Zip: - " Expiration Date: /(7-- 0
Phone: 7.5g 5-g/ Alternate Phone: 6/d cP9/ -6757
❑ Insurance—Current:
1
�+ ►. _
'[d .b,r.., y x '� g,rs�& x a 3, .; „aL`3 .
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:
❑ 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 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-3—
Outdoor Grill Other/List What&Where: Di Doe Coo K Nfie of
2 o yl�h Cl0
a �sgp
tqr-<.rr..., w.. * fi '� .asb
❑ 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 $ .50
Mail-In Fee(If Applicable) $ 2.00
4 Total Permit Fee $
� F +F6^ #g5F,4' " 4y, #U '"tr'^ .�i �,q.. 4•.Y
If above does not apply; follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
.0D O x.0125$
(contract price) (minimum$50.00)
2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50)
x.0005 $
(contract price) (minimum$ .50)
3. POSTAGE&HANDLING(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 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 of the Building Department at(952)249-4600 for the price.
'M�0 � .. .gd Y' 6- da •0., �
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: ' / �1i, Date: /6
3