HomeMy WebLinkAbout2015 - 01222 - mechanical CITY OF ORONO 111111 11 1111 I I II 1111 I I I I 111111111
* 2015 - 01222 *
2750 KELLEY PARKWAY DATE ISSUED: 09/25/2015
ORONO,MN 55356-
(952) 249-4600 FAX: (952)249-4616
ADDRESS : 450 WOODHILL RD
PIN : 02-117-23-42-0003
LEGAL DESC : REG.LAND SURVEY NO. 1098
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL-MULTIPLE
VALUATION : $ 9,000.00
NOTE: I REPLACEMENT HEATING SYSTEM(GOODMAN), I REPLACEMENT COOLING SYSTEM(GOODMAN)
APPLICANT MECHANICAL 112.50
STATE SURCHARGE MECH(VALUATION) 4.50
BLUE OX HEATING&AIR MAIL-IN FEE 2.00
5720 INTERNATIONAL PKWY
NEW HOPE,MN 55428- TOTAL 119.00
(612)238-9709 Payment(s)
Minnesota State License#:mech-MB671957 CREDIT CARD 0100 119.00
OWNER
ROSENBERG,PETER&CECILIA
450 WOODHILL RD
WAYZATA,MN 55391
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 ��Q
requested in conformance with the State Building Code.This permit may be V 1.0
revoked at any time for due cause.
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Applicant Permitee Signature Date Issued BySignature Date
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09/18/2015 FRI 12:47 FAX 612 822 5408 Al' ! Master Plumbimg UO 02/004
cC$1 / / JOB287687 CIPO80381•6
FOR CITY USE ONLY
City of Orono /c7 C�I5
PA.Box 66 Date Received: /L1/ Permit# J o lZ_2,2_
Q 2750 Kelley Parkway 7
Crystal Bay,MN 55323 Approved By: iL '' Amount$' l / 6 a
Phone(952)249.4600 Fax(952)249.4616
<Ikesrto�`c. CITY OF ORONO—MECHANICAL PERMIT
(MI Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall)
,.GENERAL INFORMATION -
I. 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 MIIST NOT BEGIN UNTIL THE
PERMIT CARD 15 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 Rccord must be submitted before final
TYPE OF PERMIT
(Check All That App1Y) .
■❑Residential ❑Commercial(Approval Required)
❑New ❑Additional ❑Repairs Replace
;4§1?Site,i! 7.'*nerin'fo,'rmatiori:
Site Address: 450 Woodhill Rd
Owner:
Peter RosenbergMailing Address: 450 Woodh ill Rd
City: Wayzata Zip: 55391
Home Phone: 612-819-4920 Alternate Phone: n/a
CODtrOtOC illiOrIllati011; •
Blue Ox Heating &Air Jennie Wood
Contractor: Contact Person:
5720 International Pkwy MB671957
Address: State Bond#:
City: New Hope Zip:MN Expiration Date:
612-238-9709
Phone: Alternate Phone:
Insurance—Current:
Owner's Insurance
1
09/18/2015 FRI 12: 48 FAX 612 822 5408 Al' a Master Plumbimg U003/004
t"l 9lildil' C 94 i ' T', ei'r tOMEENSlti O ' MEED MOP COSlli
Note:All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS THIS GEOTHERMAL? ❑Yes ❑■ No
HEATING SYSTEMS
Quantity: 1
Make:
Goodman
AMEC961205DN
Model:
Fuel: gas
Fluc Sizc:
Input BTUs: 120k
Output BTUs:
COOLING SYSTEMS
Quantity: 1 _
Make: Goodman
Model: ASX160481
4
Tons: _
H.Power
FIREPLACES
❑ Gas Fac Fireplace Brand Name:
❑ Wood Bumin -replace
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Ma my
VENTILATION
❑ No. Ki n Exhaust duct recirculating ctnn
❑ No. Bath Ex st(must have duct outside) cfin
❑ No. Other Fans: cations cfm
FUEL STORAGE (Must h pproved 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 ❑ ther/List What&Where:
2
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09/18/2015 FRI 12: 48 FAX 612 822 5408 Al' s Master Plumbimg U004/004
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❑ Yes,this section • plies
The replacement of a Residents. fixture or a..liancc that meets all three of the following requirements:
1. Does not require modi .'tion to electrical or gas service.
I 2. Has a total cost of$500.0 I .r less;excluding the cost of the fixture or appliance:and
1 3. Is improved,installed or repla••d by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
ate Surcharge $ 5.00
Ma n Fee(If Applicable) $ 2.00
1�1 ' I " ' Total '. mit Fee $7 } I
11^94 4111114 KU +h r+�i Wit8ltNi l'?dflrilfi+f,a4!K9R�f;7f re III' '4f6h"r��ihMfMW��?1 E � T'V 014 ,i m°•'�i� �1P7}t'+If V i4 �1 i t i f SIJit"}M,`fljii
If above does not apply;follow guidelines below:
I. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
9000x_0125$ 112.50
(contract price) (minimum 550.00)
2. STATE SURCHARGE 90004,50
x.0005
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ .00
1
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $1 \G\
• * 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 ordies of the City and the regulations of the State of
Minnesota, and certifies t t all( ateu+-t s made on this application arc complete, true and
correct. I
Applicant's Signature: l 1 1 bate
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