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Home My WebLink About2014-01162 (Mechanical) , . CITY OF ORONO * z 0 1 4 - a 1 1 6 2 * 27�0 KELLEY PARKWAY DATE ISSUED: 10/08/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1438 BALDUR PARK RD PIN : 08-117-23-34-0059 LEGAL DESC : BALDUR PARK : LOT 000 BLOCK 000 PERMIT TYPE : MECHANICAL(>$S00) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : MECHANICAL- MULTIPLE VALUATION : $ 6,200.00 NOTG: 1 TRANE NAT GAS& 1 TRANE 2-1/2 TON COOLING UNIT APPLICANT MECHANICAL 77.50 STATE SURCHARGE MECH (VALUATION) 5.00 RAY N. WELTER HEATING CO MAIL-IN FEE 2.00 4637 CHICAGO AVE MINNBAPOLIS, MN 55407- TOTAL 84.50 (612) 825-6867 Payment(s) 84.50 OWNER TRUST, THE HELI ROTH 1428 BALDUR PARK 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 specitied 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 applican(is responsible for assurin,all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. �=� �,.-� � (�r�-�,.�- � C G � � �lc.� Applicant Permitee Sionature Date Issued By Signature Date FOR CITY USE ONLY ,�� City of Orono �O O P.O.Box 66 Date Received: Permit n �;,;,. 2750 Kelley Parkway �a '��`��;�"-� � Crystal Bay,MN 55323 Approved By: Amoimt$: ��i� �+t�°��i".•.o`�� Phone(952)249-4600 Fax(952)249-4616 \\l,�'''�&BAO�� CITY OF ORONO -MECHANICAL PERMIT (All Commercial permits must be approved by the Buildine OYficial or Inspector and/or Fire Marshall) GENERAL INFORMATION 1. You may apply far mechanical pernuts by mail or in person at the City offices. Applications will be reviewed and a perinit will be issued within two working days. 2. Pennit cards will be sent by return mail after a review is completed. PERMITS ARE NOT VALID UNTIL YOU RECENE A PERMIT. WORK MUST NOT BEGIN tiNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3. Mechanical Desiens—Complete calculations, details and specifications are required for each heating, ventilation,hunudification-dehumidification, and air conditioning installation including heat loss/heat gain calculation, design temperatures, equipment ratinas and identification as to tyue. manufacturer and model. Data shall be presented on form provided. 4. When any new construction or remodeling is involved, a separate builduig pernut must be obtained. 5. All work must be done in accordance with the Uniform Mechanical Code/State Buildin�Code requirenlents. 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 PERIVIIT (Check All That Apply) ' [�Residential ❑ Commercial (Approval Required) ❑ New ❑Additional ❑ Repairs �'keplaceRE,�+E�VE� Job Site/ Owner Information: I i(;j �;8 ZU14 Site Address: �G/� b �/��,�If'� �i�� 6�C, CITY OF ORONO � Own�r: K�A,�i a�/ �-! Mailin� Address: / � �, r�,/�, �- City: (�f.��'Z`a�T� Zip: J S 3�� Home Phone: �S� ;,�y,�- �j��L f`7 Alternate Phone: Contractor Information: Contractor: U � , �J, rL '�': Contact Person: - � {� Address: Lf(�� '� l, l�l��UG' �i/ State Bond#: /'yl�dQ�%�� City: /l 1 ��, Zip:�� Expiration Date: �-�, �-- �(� Phone: �� v�� Alternate Phone: - � Insurance- Current: �� ' ��p�'�� ;r(df�� 1 � MECHANICAL SYSTEMS BEING INSTALLED I Note: All Geothennal Systelns will now require a Site Plan &Review by our Building Official. IS THIS GEOTHERIVIAL? ❑ Yes ['�'�o HEATING SI'STEMS Quantity: � Make: �!►/a�L� Model: 7G1/,/ /Ol� Fuel: � ✓ Flue Size: � � 3 � Input BTUs: /��i�i`l�-' Output BTUs: ----`�'L� CFM: COOLING SI'STEA'IS Quantity: / Make: ��l� Model: �-/%%� 3 b��,� / To�15: � a _ H. Power FIRFPLACES ❑ Gas Factory Fireplace Brand Name: ❑ Wood Buining Fireplace . ❑ Wood Stove Model No.: - ❑ Wood Stove with Flue/Masonry V'ENTILA 1'IuN ❑ No. Kitchen Exhaust duct recirculating cfm ❑ No. Bath E�iaust(must have duct olrtside) cfm ❑ No. Other Fans: Locations cfm � FUEL STORAGE (Must be approved by Fire Marshall if proposing to aba�idon tank in place.) ❑ Installation ❑ Removal Fuel Oil: gallons ❑ Underground ❑ Inside ❑ Outside LP Gas: gallons Other: ` GAS LINE ONLY ❑ Outdoor Grill � ❑ Other/List What&Where: � 2 � � PERMIT FEE CALCULATION(S) BASED OFF - 2UO2 STATE STATUE ❑ Yes,this section applies The replacemei7t of a Residential fiature or appliance that meets all tln�ee of the following requirements: 1. Does not require modification to electrical ar gas service. 2. Has a total cost of�500.00 or less; e�cludin�the cost of the fixnire or appliance: and 3. Is improved, installed or replaced by the homeo��ner or licensed conn-actor. Skip next section,if tlus applies; Cost of Pernut $ 15.00 State Surcharge $ 5.00 Mail-In Fee (If Applicable) � 2.00 Total Permit Fee $ � PERMIT FEE CALCULATION(S) —JOBS OVER ��OO.OU � If above does not apply; follow guidelines below: 1. CONTRACT PRICE * is 1.25% of contract price with a(Minimum Fee of$�0.00) , �� (^., ,a�00 c� x .0125 $ ��- L (contract price) (minimum$50.00) 2. STATE SURCHARGE ** Add the State Bldg Code Div. Surcharge (Minimum Fee of�5.00) O�— X .0005 $ `�j— (contract price) (minimum$5.00) 3. POSTAGE &HANDLII�TG(Oniy on Mail-In Applications) � 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ G� �D a� ■ * COI�rTRACT PRICE or JOB COST means the actual or estimated dollar amomlt charged for the pernutted 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 o��ler, tenant or any oflier party, the reasonable market value of such items must be added to the ' estiinated cost or contract price for pernut fee purposes. In the event that there is a dispute on the ainount cf the ioo cosi, ihe City may request the subnussion of a signed copy of tile actual conu-act. ■ ** The STATE SURCHARGE is .0005 times the Conn�act Price or a minimum of��.00. MECHANICAL PERMIT APPLICATION AGREEMEI�?T � 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 Qn this application are complete, true and con�ect. , - �- �� ,�7 Appl�cant s Signature: �� Date: �6�• /�� 3 ,aco� CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DD/YYYY) `-� 9/5/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEACT C@Tt1f1Cdt2S Department Kraus-Anderson Insurance PHONE (9SZ)7O7—HZEZ FAx AIC No: �952)890-0535 420 Gateway Boulevard AooRE :certificates@kainsurance.com INSURER S AFFORDING COVERAGE NAIC# Burnsville NIN 55337-2790 iNsuaeR n Amerisure INSURED INSURER B: Ray N Welter Heating Company INSURERC: 4637 Chicago Avenue INSURERD: INSURER E: Minneapolis MN 55407-3512 INSURERF: COVERAGES CERTIFICATE NUMBER:14/15 Certificate REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'LTR TYPE OF INSURANCE ADDL SUBR pOLICY NUMBER MM/DDY/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1�OOO�OOO X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eaoccurrence $ 500,000 A CLAIMS-MADE �OCCUR PP2089207 9/1/2014 9/1/2015 MED EXP(Any one person) $ 1�,�0� PERSONAL&ADV INJURY $ 1�OOO�OOO GENERAL AGGREGATE $ 2�OOO�OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ Z�OOO�OOO X POLICY PR� LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident 50� ��0 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 2099201 9/1/2014 9/1/2015 BODILY INJURY Per accident $ AUTOS AUTOS � � HIREDAUTOS X NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident X Notice of Cancellation $ 60 Dd S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1�OOO�OOO A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1�OOO�OOO DED X RETENTIONS U2089203 9/1/2014 9/1/2015 $ j.� WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ SOO OOO OFFICER/MEMBER EXCLUDED? N�A (Mandatory in NH) C2089205 9/1/2014 9/1/2015 E.L.DISEASE-EA EMPLOYE $ 500 D00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ SOO OOO DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is requlred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WIIL BE DELIVERED IN City Of Orono ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 66 27'rJ� Kelley Parkway AUTHORIZED REPRESENTATIVE Crystal Bay, MN 55323 �_/��--- Jim Klym/SBOSCH � ACORD 25(2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025(zo�oos�.o� The ACORD name and logo are registered marks of ACORD � l MINNF�T�DFP,.�TF.lFN�OF MECFIANICAL CON�'RACTOFt �OND � LABQR$c IN�USTRY Construction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road N SL Paul,MN 55155 Website: www.dli.mn.qov/ccld.r.sp Email: dli.licenseCa�state.mn.us Phone: 651284.5034 This is to certify that the certificate holder is registered as a MECHANICAL CONTRACTOR BOND in the state oi Minnesota and is in compliance with Minnesota Statutes 326B.197,and has filed a$25,000 mechanical bond to perfonn gas,heating,ventilation,cooling,air conditioning, fuel burning,or refrigeration work in all areas of the state during the registrarion period;provided the work perfoi7ned complies with the State Mechanical Code and the certificafe holder maintains compliance with the required bond and workers'compensation laws. Registration : MECHANICAL CONTRACTOR BOND � RegNumber : MB0o3163 RAY N WELTER HEATING COMPANY � a Effective Date : 08/21/2014 4637 CHICAGO AVE S � Expiration Date : 08/21/2016 MINNEAPOLIS, MN 55407 � T VERIFY UP-TO-DATE STATUS, BOND,AND INSURANCE INFO AT www.dli.mn.qov/ccld/LicVerifv.asp (ENTER NUMBER). V G � � DATE _ / TIME CITY OF ORONO CALLED IN //-/� /�� INSPECTION NOTIC �/ �HEDULED /�/c�—/(� /•'O� PERMIT NO. /��!/`� �G�- ADDRESS�� OWNER � S T HONE N0.�5O�-a�a��7 CONTRACTOR �: DESCRIPTION ��u/t-��A,GI . ��Nl-w[ � - - � ❑ FOOTING ❑ PLU BING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL CHANICAL RI ❑ LAKESHORE/WETLANDS � O FRAMING MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION OOD 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 COVEFi REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a � � 0 �. � 0 � W � Q � 2 W � W � J W ❑WORKSATISFACTORY:PROCEED OJECT COMPLEfE � ❑CORRECT WORK 8 PROCEED ❑ IS E CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pH0T0 TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in dvance. -4600 OwnerlContractor on site: Inspector. White Copyflnspector's File Canary CopylSi Notice �-7 ✓ `�?��-- DATE TIME CITY OF ORONO CALLED IN -� INSPECTION N TIC SCHEDULED � - � PERMIT NO. � � MPL ED ADDRESS � �� OWNER TEL HOG��/l/ ^ � CONTRACTOR ry >; DESCRIPTION �`" -— � tL ❑ FOOTING ❑ PLUMBIN FINAL ❑ EXCAV/GRADING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � Q ❑ FRAMING �ECHANICAL 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 � O PLUMBING RI O SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERfCONTRACTOR TO MEEf YOU:_YES_NO � CGMMENTS: � G ��.ye T IN-`l�.--�3« - 8 �=6�6 ? � -�-- . � �a - � 75� �7g! � . 1►�,r�_��to�./� rt5p ac�ro^, - 1/Q .q� iK doL` �Q'i � /�l��t �f 4G�4/r�'�C�r0 r.l7��f ° ��Q ow na��. s��t� f� �K.S�QlIQ.� cl,.� W Q l�e�'l��c`s !S .G�r C4✓r r� C��Q — 2 " �'4 �le� /�t SL��L/le✓ T6 piD vc,a� /il�o '_ W � � ��R'/�. Q C/ � OfOM.� , /►�l f'j . L!S • j W ❑WORKSATISFACTORY:PROCEED ❑ PROJECT COMPLEfE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-46�� OwnerlContractor on site: Inspector._��--- � White Copyllnspector's File Canary CopylSite Notice �� DATE TIME CITY�F�R�N CALLED IN �� ' � —�-� INSPECTION NOTICE SCHEDULED / - ' � � PERMIT NO c,�2�T��-`O LETED ADDRESS � � ��'�- OWNER 0 TEL HON NOgs��5�� CONTRACTOR , � DESCRIPTION ��'��'�J ��"-`-' � � ❑ FOOTING ❑ PLUMBING FINAL p EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ IAKESHORE/WETLANDS � ❑ 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 COVEfi REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO c�., COMMENTS: q I/G�►�f��lS r of'�� 1/�HL� '�i�r� L��l ' � � � �j �rb(// -G / G�'�S�t�?G� �✓G r.v` bQ� lo�G t�`— � l.rJ/'lllf7u c.� 1�e � 4��c S — W " � Q 2 C�� `( 6� r Ci �s d �/o.� W � W 2 j W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE � ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pH0T0 TAKEN INSPECTOR WILL RETURN ❑STOP ORDEH POSTED.CALL INSPECTOR �CITATION ISSUED INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 OwnerlC tractor on site: �� Inspector. /� - - - - White Copyllnspector's File Canary CopylSite Notiee