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� CITY OF ORONO PERMIT NO.: 2010-00245
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 04/20/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 4250 FOREST LAKE DR
PIN : 07-117-23-12-0022
LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN
: LOT 000 BLOCK 002
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTIOIV TYPE : HEATING SYSTEMS
VALUATION : $ 4,000.00
NOTE: 1 RUUD NATURAL GAS FURNACE
APPLICANT MECHAN[CAL 50.00
RON'S MECHANICAL, INC. STATE SURCHARGE MECH (VALUATION) 2.00
12010 OLD BRICK YARD ROAD
SHAKOPEE, MN 55379 MA[L-IN FEE 2.00
(952)445-8585 MISC FEE 0.00
TOTAL 54.00
OWNER
ETAL, ROBERT DONGOSKE
4250 FOREST LAKE DR
MOUND, MN 55364
AGREEMENT AND SWORN STATEMENT
I he work for which this permit is issued shall be performed according to
thc 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 ofwork
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 f'or a period of 180 days at any time afrer work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the S[ate Building Code.This permit may be
revoked at any time for due cause.
��y�'��l. �- l l �//''t�--y( l l
Applicant Permitee Signature Date Issued By gnature ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO .
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CITY OF ORONU- MECHANICAL NERMIT
liAU(���inmcici.il permil,�inu.t he aG�provc�I�c lhe Buildin�OIT�icial�ir In.pc�tor anJ.�,r I�uc i�9er>liall)
GENERAI_ INFORMATIUN
1. You may ;ipply I�n�mechanic<il permits t�y mai] ur in person at lhc CiCy ofCiccs. ApE�li�afi��n,�+�ill
he re��ie��ed and a penni�w•ill be i�s�icd within twu we�rking dayti.
_'. PcrmiL c�u��is will be ticnt hv return niail ai�ter�review is com�letcd. PF_.RMI"l'S f\RF NO"I�
V�LI,ID LNTII.YC�U REC;F,IVE A PE.I2MIT. WORti 1�1I_!ST NOT I3EGIN UN7'll,"1'HI?
1'EK�ti1IT CARD 1S POSTf�.D ON THL;J06 SITE.
3. Mechani�al Desi�,ns- Cumplete calculations.details and tipecifica�iuns�irc rcyuiral lin c;ich
hc<itin��, �'cniilalion, humidil�icalion-dchumi�lilicxtiun,and air��mclitiunin« insl.�llati��n in�luclin��
hc<it luti�,ihcal gain calculaiiun,dcsign Icmper��turc�.cyuipntcnl ra�in�s,ind i�IcntiCi��alivn ;is lu
tV►?e.�nttnuf�aelurcr an�i nw�1�l. Data sl'�ail hc prc5cntcci un forni pruvi�3ud.
��. Wh�n xn�' nu�v�unsU�uction��r remodclin�= is inv��lvcd, a�cnaratc l�uildin�,���crmii nius( hc
�,t�ixine�l.
�. All ���ork i��usl he�I��n� in acc��r�iancc wiih thc Unif�n�m Mcch<u�ical Co�IcrStaic f3uildin� Cncic
rcyuiremcnt..
(�. Atl ���orl: must hc inspccicd (rou�li-in an�1 linal). Cal] (�)�2)?�1�)--�(�l)(1.
(24--18 hou►•notice rec�uired)
7. f{ou�c flraling'l�csl Rc�or�i must bc suhmitl�d hcli>re Cinal.
TYYE OF YERM(T 1
� � (Chcck All That Apply) I
[�Rcsideniial � Coiuuicrcial (Appr��val Reyuirc�l)
� Ne�a [�Additional � Re��airs �12c��larc
Ji�b Site / Owner Inform��tion:
s���: n�����,�: �"2� ���5� �� �� MC�C111�1�
()wn�r: Vv� 1� �J /�� Mailing Address: 1��� �V�� �t'�- �1 jl�
City: Orono 7..ip: - —
f�io�ne Nhune: ��L ���� Alternate Pl��one:
Contractor Inf��rma[ion:
Cc�ntractoi: Ron's Mechanical Inc Contact Persori: Linda_
12010 Old Brick Yard Road ��'_ �(�' 1�1.�
Address: State F3ond #:
�.�ly: Shakopee Z��: 55379 E�piration Uate: 0'��" ��
Phune: (952)445-8585 Alternate Phone:
Q Insurance-Current:
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^ MECHAN[CAL SYSTEMS BEING INSTALLEU ,
N��tc: /\II Grutl�cr�nal Systcm;wil] n��w reyuirc a Site Plan & 12cvicw I,y ��ur 1�3uilciin��Ulfiri,il.
Iti Tf�IIS GI;(.�)Tlii�;Rl�l_�1L? ❑ Ye.s [�No
IILATING SYS7'EMS
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f L N�����•t — — —
1�71t1�:PL�1C[:S
� G<u Facle�ry Fire��lacc l3rand Naute: __ –
❑ Wu��� 13urning FireE�larc
� Wu���l SR�vc Mudcl N��.: -------
Q WuuJ Sluvi� Witli Flue
� i�:ti�rii,n�ric�N
❑ No. I<itchcn F:ah�iu�t �lurt recirculaiin� _ cl�in
❑ Nu. liath Exhaust(must h��v��luct��ui�i�le) _rl�ni
� N". --- O�hrr t�ans: L���•aliuns __�Ini
I�U[?1.ti7'OItAG� (�1/us�be upprored Gy I�ire Marsltcrll if pru��osi�tg to uGtrnduir/rrnk r�r pince.)
Q� Installati�>n � Rcutuval
Fucl Oil: baU��ns ❑ Un�Icr�;r��wiJ � In�i�lr �Oulsi�lr
l,F'Gas: _ �all�>nti
(.)Ihrr:
1:15 LIM�:ON1,1'
❑ Ou�dour Grill � (7thcr/List VVhat J'c Wherc:
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��20-2009 04:21pm From-CITY OF ORONO +9522494616 T-862 P.003/003 F-144
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i�;��� . ,I„���� �I�I��t��i o Ii��!�il8i{III��I� -'�� 4 I7�. . . 1R4 I(� � .��I� I i} j �II �� �hi f 1I i�`��.li �� �� � (i
1I$�' �f� Y i(�Iu�1��.�'�j1� �t�� II�%I �l,��I ,� I ''.I��i.f.�l I S t � 1� •i. �C� J` �tL'H I �i � � �I i� I1f I.i 7 � �+�� i.��
1F� ,7 � �itl{,'+�I��iI i��� Il�lil � ��i�.�yi �,�y� �ll ,�!��� I�r � h jI'�I �} ffI,�� � 1� I,�I��, �I�
�,i �;����� r�I'-�,s�l}�`ll!i f���iixr���i�4131.��,N�I,'i:�,�1��1.� .�I�il�*i'r ,Tr, � +;I. ..W' �` �=rt'I�I'�1:�'r � �, 'i`��jI�H'li��I��li�I lu:�l�li<<���� �u�1 Ij����l'�!',llif����;,!.il'1��i�
� Yzs,this secrion applics
The rcplacernent of a Ttesidenrial fixnuc or appliance that meets all tI�ree of the followi���;requirements�
i. Docs not requu•e modificatiar�to elecuical or gas service.
?, Has a t�tal cosc of$500.00 or less;excl 'n the cvst of the fixturn or ap}��iancc:$nd
3. Is improved,installed or rE•placcd by rhe homeowner or licensed conuacrc�,•.
Skip nzxt secti�n,if this applics; Cost of pernut $ 15.00
State Surcharge $ _50
Mail-In Fee(If AppliCable) $ 2.00
Total 1'ermit�ee $
, ��,��.��� �f �(��(� J {
�.� � �. -.1 �i� �Mldlll .1�7nr,� �� ,l. .t�.i � .u '�"71jA N�����;���6���J���V;�Ij�i�l�I�'����{i1��lii
If above does not apply;follow guidelines below:
1, CONTRACT PRICE *is 1,25%of con�rAct price with a(Minimum�'ee of$50.00)
�Db� X_o�z�$
(con�ract pricc) (i ninimum 55U.00)
2. STATF SLJRC:HARGE '"*Add the Srazz 131dg Code Div. Surcharge(Minimum 1Fee of 5.50}
x.000s $ �-•b�
(C6t1VAC[priCd) 1i��inimum$ .SO)
3. pOSTACrL 8r HANDI.II�TG(Only on Mail-In Applications) $_. 2.00
4. TQTAL P�RMIT FE�:(Add�,ines 1-3 Above) $___,_ _�•��
■ * CONTRACT PRiCE or JOB CQST means the actual or esrimated dollar am��unt charged for the
permitted work including macerials,IAbor,profit, and othzr fixed cosis. Tt is the anwunc to be charged
to tue customcr for the work done. If any materiai, equipment, labor or installat�ons are furnished by
rhe owner, tenant or any ocl�rr pariy, the reasonable markez value of such items rmist be added to the
escimatcd cost or conrrAct price for permii fee puiposes. In the event that rher: is a dispute on rhe
amount of the job cost, the City n�ay rcqucst the subuiission of a signed eopy oi thc actual cantract.
■ **The STATE SU�tCHARGE is.00OS of rhe Building Departmzn[at(952)249-4600 for tlze price.
�� d li�'- �� !1�I I1 t� I k1 i i�' �� �tA=�.�i � I l , ' � I. � ' ��+:�Aill��li�_��'�f 1�,jri IIj jf�ZSt!�1 i l�i
1: { ..I.,�� .r'l� �
The undersigned hereby applies to the City for issuance vf a Mechanical Pernlit, asrees to do all
work in strict accordance with the ordinanc�s of the City and the regulati��ns of the State of
Minnesota, and certifies that all statements made on this application are �:omplete, true and
correct.
Applicant'� Signatttre: ��� Date: �� J�
3
� � E TIME V
� D
CITY OF ORONO CALLED IN
INSPECTION NOTIC SCHEDULED - — O _'D CJ
PERMIT NO. ������`?� COMPLETED
ADDRESS T Z�d �d��f ��`�`� ��
OWNER �� ���� TELEPHONE NO. ��Z ��� �O�/�
CONTRACTOR 4-ltD /f/IC��C�"t�
>; DESCRIPTION �1�� ��r�ace ��=���
�
ll� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
� ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
�
O ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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GW ❑WORK SATISFACTORY:PROCEED PROJECT COMPLETE
� ❑CORRECT WORK 8 PROCEED ;i ISSUE CERTIFICATE OF OCCUPAN�Y
W
0 ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. G PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Ca11 for the next inspection 24 hours in advance. (J52� 249-460�
Owner►Contractor on site: �
Inspector. �'
White Copyllnspector's File Canary Copy/Site Notice