HomeMy WebLinkAbout1983-7275 (mechanical) +M► ''� -
.CAL PERMIT CITYYERMITNU. _-�2�5 +
. OF ORONO � _S�
P.O.BOX 66 Date � �
fAL BAY, MINNESOTA 55323
(612) 473-7?57
�-�� � Address � � � ���(l/l_ �
r - � Address � " �
.;ense No. State License No.
ARKS AND SPECIAL CONDITIONS
^ ������. � ��
PERM[T TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR
lnside Plumbin� ( # fixtures ) Fee $ On Site Septic System Fee $
Water Meter (Size ) Fee $ Water Well Fee $
Meter # �
Mechanical Equipment Fee �
Remote#
Municipal Water Connection Fee $ Moving�Lifting Buildings Fee $
❑Copper ❑ Land Alteration (Excavation, Fee $
Grading, Filling, etc.)
Municipal Sewer Conn�ction Fee $
❑ PVC ❑ Cdst n Other: Fee $
MWCC SAC Charge Fee $ After-the-fact Investigation Fee $
ACKNUWLEDGEMENT TOTAL
Tt�e undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information, /�
terms, conditions or requirements written above. The State Surcharge: Fee $ • v C',
undersigned understands and a�ees under penalty of law
Lhat this permit is stricUy limited in scope to the work, �
activity or improvement specified; that this perxnit does �
not grant any authority to do work or activities requiring Total Amount Paid to City Fee $
sepazate permit approvals; and that this permit does not
�ant autttority to violate any p'tovision of any City
ordinance or State law,rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
codes and/or health department regulations, and shall be This permit is not valid Ulltll t�le ]�1'Oj�er fee 1S polC� �llllj
subject to inspection, approval or reiection by the c�ty. it is approved by an authorized City Official.
Whenever so ordered, the undersigned agxees to correct
any work found to be in violation of the conditions of
this permit.
Si n re of Applicant � Sign r of City Offi 'al �.
� � � ,� � � _
Code: White—1 ile Copy Canary—Inspector's Copy Pink—I inance Copy Gold—Applicant's Receipt
� . �
��r�a� ��.-� ����� APPLI CATION FOR
�ec�a����Il PD�e�mi�
GENERAL INF012MATION
7. Vou .�ay appCy 6ua mechantcal pcnmlta by maiC o1 in pcaeon al Zhe Cily o6d<cea. Wa1Ced-<n pclmita aae aubject to the
yu�lage and hand[ing 6eee ehown beLow.
1, Ven.�i[ calde will be etnt b� a¢luan mai.0 the aam¢ dai� the appC(eation (e �ecelved. PER�II7S ARE NOT VAL1D 11NT11 YOU
RECEIVE A VCRuIT CARD. UJKK �IUS7 N07 6EGIN UNTJI THE PERIAIT CARD ]S VOS7E0 ON 71(E JOB SI7E.
3. When any new conetauction oa nemodeCing ib in�oLved, a eepanate Gui[ding peamit muet be obtalned.
I. A U wuak �nuet be done <n accoadance wtth State 6uElding Code tieQuinementa.
i. ACC woak must b¢ inepeeL�C �aough-in and 6inaC). Ca U J13-1351 1/-houa notLct aequined.
6. Houat Neating 7eat ReconG musl be eubrn<Lted b¢6oae 6tna1 - a¢e atlached.
I N S T RU C T I 0 N S CompLete a�C iteme on Zhia appL,ication. Compute th¢ pelm<t jee. Slgn and date .ihe ceati6<catEon.
)NCOilYLE7E APFLICA7JONS W111 NO7 BE PROCfSSEU. Ij you have questtone, caCG 17)-7357
WALK- 7N VCRh177S App.�y a,t C�..ty p6U�.ce�s , 1335 Sou�h Bnown Road ( C.ty. Rd. 146 )
MAIL- IN PERh{ITS Fne.2oae �ee bda�..� .�o • P. U . Box 66 , Cn�a�ta.� Ba�, Mn. 55323
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JOB SITE �
Occupancy Type: _ a¢ .cd�nttal co�n.en aL; Othea
Owner ' s Name ,,�� Telephone Number
r
Mailing Address
Contractor ' s Name `�- Telephone Number y�)� � ���,
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Mailing Address �- � A� ,�, -Z � �,��,
******x*********�*******�******************�**************** ******************
MINIMUH FEE (520.00 per project)
...�................................�........�...�........�a.....�...�..r.�......�.•..�............•....•............•.•....
HEATINC SYSTEHS $1,5.QGench unit
VEL � nnt. gas, _ lp 9�s, _ oil, _ clect.
other (spacify if combination burner)
IP. (if more thnn 1 unit per bldg., list cach aeparatcly)
Type Dtuh Input Dr d Namc Model No.
f. a. furnace 17s�'� `(,� r � n,�Z�� /75�
- � DATE TIME
CITY OF ORONO CALLED-IN
INSPECTION NOTICE SCHEDULED ' ' �
PERMIT NO. COMPLETED �a '��-�3
ADDRESS -
OWNER CONTR.
TELEPHONE NO. __ _
❑ FOOTING p PLUMBING RI ❑ SITE INSPECTION
� FRAMING ❑ MECHANICAL ❑ EXCAV./GRADING/FILLING
� ❑ INSULATION ❑ WATER HOOKUP ❑ LAKESHORE/WETLANDS
� ❑ WALL BD. p METER SET/TURN ON ❑ LICENSING
t� 1J FINAL ❑ SEWER HOOKUP ❑ COMPLAINT
� ❑ PROGRESS O SEPTIC INSTALL. ❑ FOLLOW-UP
� ❑ DEMOL. O SEPTIC MAINT. ❑ SEPTIC FINAL
O � FIRE PREV. ❑ WELL TEST PUMP �
= COMM ENTS: TT
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pW p WORK SATISFACTORY: PROCEED ❑PHOTO TAKEN
❑ CORRECT WORK&PROCEED
V ❑ CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING
❑CORRECT UNSAFE CONDITION WITHIN HOURS. INSPECTOR WILL RETURN.
❑STOP ORDER POSTED.CALL INSPECTOR.
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
call for the next inspection 24 hours in advance.
Owner/Contr. on site
,
Inspector�01+ti �� � � - 473-7357
White Copy/Inspector's File Gold Copy/Site Notice
HOUSE HEATING TEST RECORD
` CJKC� �
ADDRE55 ! ��� � ��y � � p� � �� APT. FLOOR GTY SUBURB
OCCUPANT �.,.q � S w��� � ;–�j •�� OWNER� f�
HEAT LOSS � � DATE HTG. INST.
SOLD BY�,,��L- ,��%�'Tr� l�� INSTALLED BY ���iL
Electrical Work By Gas Line By���
TYPE OF HEAT GA FA VHW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE IL�� f"'1 � �L I�C� � L MAKE OF BURNER
Model /n� �/7�� Sl/�ca� Model
$erial ���31L> ✓7b'-3 S Max. BTU Rating
INPUT I 7��%��� ��� MAKE OF FURNACE �
Model
CONTROLS
THERMOSTAT`�� 7� Heat Plug Vent Size 7 `` L1 �1 ��- �
Valve ll N!'t14 d` KIND OF LINER SIZE NONE
Limit H 41V('-`� W�LL Draft Hood ����� Regulator
Limit Setting aGG° Filters $ize -���'-x 3�.—Number �
Fan Settin U"'�l,U
g Chimney Location Inside Outside
Pilot Type `S����` Chimney Construction �1L'�
PilotMake ��N��L1'
Pilot Model $moke Bomb Wiring
Pilot Timing � Draft �1 r� TesT Tag ���5 .
L.W. Cut Off Door Pressure Lighting Inst. �
Pressure � �S v Percent CO2 ' v Date Tested 7�2� � Q�
InputCFH ��� G` �� Percent 02 6"�' �ft1 Company Testing
Stack Temp. �7� d Percent CO r�'U "1C� Name of Tester
Form 235