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Home My WebLink About2012 - 00153 - gas line only CITY OF ORONO III I II II I II 11111111 IIIIII * 20 1 2 - 00 1 S3 * 2750 KELLEY PARKWAY DATE ISSUED: 02/22/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 4550 WOLVERTON PL PIN : 31-118-23-31-0005 LEGAL DESC : FOXFYRE ESTATES : LOT 001 BLOCK 001 PERMIT TYPE : MECHANICAL(<$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : GAS LINE ONLY NOTE: RUNNING GASLINE ONLY FOR FIREPLACE APPLICANT MECHANICAL(<$500) 15.00 G-HVAC STATE SURCHARGE MECH(<$500) 5.00 16036 MALLARD WAY SE PRIOR LAKE,MN 55372- TOTAL 20.00 (612)619-9322 PAID WITH CC# 9457 OWNER STEPHENSON, REVIS L 4550 WOLVERTON PL MAPLE PLAIN, MN 55359- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoke at any time for due cause. 2-/ ?-2112,_ (44,&_ � Applicant rmitee Signature Date Issued y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. FO IT SE ONLY City of Orono 0:143:4; ) D//_ 0/r3 P.O.Box 66 Date Receiv •""555°°°:� i�ermit# a•r 2750 Kelley Parkway Crystal Bay,MN 55323 Approved By: Amount$: o 0, .4:j'$� Phone(952)249-4600 Fax(952)249-4616 11104 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) ❑Residential ❑ Commercial(Approval Required) ❑ New Additional ❑ Repairs ❑ Replace Job Site/ Owner Information: Site Address: 41,)/t/ei('� Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: 11/4-C- Contact Person: 7- Atdres"s m(t" of 56 State Bond#: C' dip: 'Z Expiration Date: /7- /2- Phone:(21 f q- q3 Z 7 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 Quanti : Make: Model: Fuel: Flue Size: Input BTUs: Output BTUs: CFM: COOLING SYSTEMS Quantity: Make: Mod- . Tons: H.Power / Jr 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) 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 -r: GAS LINE ONLY F 13. LI Outdoor Grill ❑ Other/List What&Where: 2 .}.3..` q1 P Le 3 $ i : 7 , '1 g q xis 35 3 dl f54, � _ t `^ re 427 ❑ 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 $ R4:71' ;:!7:$5.7717.'17, 7retFrqrrility7r17.07qS0717:17.7,-rN,:171771)11 47.19 If above does not apply;follow guidelines below: 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) 6TT-) x.0125$ / t7-0 (contract price) (minimum$50.00) 2. STATE SURCHARGE x.0005 $ (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ ). 4. TOTAL PERMIT FEE(Add Lines 1-3 Above $ C- V `� '� ■ * 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. !,: #1111M tikes�';F� t �Mw ..»!Vh$Idh �l E•Ij I�.d �h�£IY7'1�Wbal �,R94 f,+g � Y �`kkL ¢ E'A�Ba1�s� Ei�3u� �.I�y45 '. 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: 3 CITY OF ORONO 2750 KELLEY PARKWAY ORONO, MN 55356- 249 -4600 FAX: (952) 249 -4616 ADDRESS 4550 WOLVERTON PL PIN 31- 118 -23 -31 -0005 LEGAL DESC FOXFYRE ESTATES LOT 001 BLOCK 001 PERMIT TYPE MECHANICAL (< $500) PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE GAS LINE ONLY NOTE: RUNNING GASLINE ONLY FOR FIREPLACE APPLICANT G -HVAC 16036 MALLARD WAY SE PRIOR LAKE, MN 55372- (612) 619 -9322 OWNER STEPHENSON, REVIS L 4550 WOLVERTON PL MAPLE PLAIN, MN 55359- 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 due cause. Applicant Permitee Signature Date * 2 0 1 2- 0 0 1 5 3* DATE ISSUED: 02/22/2012 MECHANICAL (< $500) 15.00 STATE SURCHARGE MECH (< $500) 5.00 TOTAL 20.00 PAID WITH CC # 9457 Issued By Signature Date 13i.r-rxr --i 1 F- r- LAk1v11 13 r'CyU1rxr,U rkJA W UMN U 1 HLK 1 HAIN UtS )UK-1t3t L) At3UV I✓.