HomeMy WebLinkAbout2015-00510 fuel tank removal CITY OF ORONO * Z 0 1 5 — 0 0 5 1 0 *
2750 KELLEY PARKWAY DATE ISSUED: OS/06/2015
� ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 4205 FOREST LAKE DR
PIN : 07-117-23-12-0027
LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN
: LOT 005 BLOCK 003
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FUEL STORAGE TANK REMOVAL
VALUATION : $ 1,950.00
NOTE: INSPECTIONS ARE DONE BY FIRE MARSHALL,JAMES VAN EYLL.
PLEASE CALL JAMES VAN EYLL DIRECTLY AT:(952)473-9701 TO SET UP AN INSPECTION.
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 0.98
DEAN'S TANK INC. TOTAL 50.98
P.O. BOX 22515 Payment(s)
ROBBINSDALE, MN 55422 CREDIT CARD 1599 50.98
(763)535-0194
Minnesota State License#: BUIL-475
OWNER
LEMIRE,JEROME
4205 FOREST LAKE DR
MOUND, MN 55364
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 sepazate
permits. All provisions of laws and ordinances governing this rype of wotk
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 aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
��.�
} �..,.
� a� c L_. `�� � `_ �_ � y.�c� �, � J_, � �,._ � r �
Applicant Permitee Signature ate [ssued By Signature Date
:
R C TY USE ONLY
/�� ,"�� City of Orono �� �S� _rf/�/J/' S��
� I�/� P.O.Box Gfi Date Receiti Permit# V�v�
2750 Kelley Parkway ,� �/�� (�
�t Crystal Bay,:�IN 553?� Approved By:��� Amount S: (J . [
/
� Phone(952)249-4G00 Fax(95�)249-4616 ��5� �e�
�iy � 1.�. � ,/�l�J�
��� ,�,`' CITY OF ORONO—MECHANICAL PERMIT v
, kes w�-�� e
'^�.�,__,�-- (All Comuiereial prnnits must be appro��ed by the Building O$ioial or Inspectur ancirbr Fire Marsliall)
GENERAL INFORMATION
I. Yc�u may apply for mechanical pennits by mail or iu person at the City offices. Applications«�ill
be re�iewed and a permit will be issued within two working c11ys.
2. Pennit cards�rill be sent by rehirn inail after a review is campleted. PERMITS ARE NOT
VALID UNTIL YOU RECENE A PERMIT. WORK�IUST NOT BEGIN UNTIL THE
PERiV1IT CARD IS POSTED ON THE JOB SITE.
3. Mechanical Desi�ns—Coulplete c�lculations,details and specitications are required for each
tieating,ventilation,lminidification-dehumiditication,and air conditioning instaliatiou including
heat loss/heat gaui caleulation,design tetnperahtres,equipment ratings and identitication as to
type,mauufacturer ana model. Data shall be presented on fo�m provided.
4. When auy new coustruction or remodeling is involved,a seParate building permit must be
obtained.
5. All work must be done in accordance with the LJnifonn Mechanical Code/State Building Code
requiremeuts.
6. All work must be inspected(rough-in and tinal). Call(952)249-4600.
(24-48 hour notice required)
7. House Heating Test Record ii�ust be submitted before final.
TYPE OF PERMIT �
(Check All That Apply)
X❑ Residential ❑ Conunercial(Approval Required}
❑ New ❑Additional ❑Repairs ❑Replace
Job Site/ Owner Infornlation:
Site Address: 4205 Forest Lake Drive
Owner: Jerrv Lemire Mailing Address: Same
City: Orono Zip: 55364
Hoine Phone: Alternate Pl�one: 612-280-0984
Contractor Information:
Contractor: Dean's Tank, Inc Contact Person: Douq
Address: PO Box 22515 State Bond#: 0475
City: Robbinsdale Zip:55422 Expiration Date: 3/25/17
Phone: 763-535-0194 Alternate Phone: 612-812-7697
� Insurance—Current:
1
• �,
MECHANICAL SYSTEMS BEING INSTALLED
. Note: All Geothermal Systems will now require a Site Plan& Review by our Building Official.
IS THIS GEOTHERMAL:' ❑ Yes 0 No
HEATING SYSTEMS
Quantity:
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING 5YSTEhIS
Quantity:
Make:
Model:
Tons:
H. Power
FIREPLACES
❑ Gas Factory Fueplace Brand Name:
❑ Wood Burnuig Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove witli Flue/Masonry
VENTILATION
❑ No. Kitchen Exhaust duct recirculating cfm
❑ No. Bath Exhaust(uiust have duct outside) cfin
❑ No. Other Fans: Locations cfin
FUEL STORAGE (Must be appro►�ed by Fire t�larshull ijproposing to abandnn tnnk in pluce.)
❑ Instlllation � Removal
Fuel Oil: 1,000 gallons � Undergrotmd ❑Inside ❑Outside
LP Uas: gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill ❑ Other/List What&Where:
2
. �►.
' � PERMIT FEE CALCULATION(S) ' �� � �
BASED OFF - 2002 STATE STATUE `
❑ Yes,tliiv sectiun applies
The replacetnent of a Residential tixture or appliance that meets all three of tlie following requirements:
I. Does not require moditication to electrical or gas service.
2. Has a total cost of$500.00 or less;excludinQ the cost of the fixhire or appliance:and
3. Is iinproved,installed or replaced by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Pennit $ 15.00
State Surcharge � 5.00
Mail-In Fee(If Applicable) S 2.00
Total Permit Fee $
PERMIT FEE CALCULATI4N�S� —�C�BS (J�ER $500.00 �
II above does not appty, fol(ow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Alinimum Fee of$50.00)
$1,950.00 x.0125 �
(contract price) (minimum$50.00)
2. STATE SURCHARGE
$1.950.00 x.0005 $
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
■ * CONTRACT PRICE or JOB COST ►neans die actual or estiinated dollar amount charged for the
peiniitted work including materials, labor, protit, and c�tlier tixed costs. It is the amount to be charged
to the customer for the work d�ne. If any inaterial, equipment, labor or installations are furnished by
the owner, tenacit or any other party, tlie reasonable market v11ue of such items must be added to tlie
estimated cost or contract price for peimit 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 ach�al contract.
MECHANICAL PERMIT APPLICATION AGREEMENT
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 eomplete, true and
correct.
Applicant's Signature: ��Gli�'� .L.-/v�.r2�� Date: 4I30/15
3