HomeMy WebLinkAbout2015-00436 - mech , ,
CITYOFORO O * z015 - 00436 *
2750 KELLEY PA WAY DATE ISSUED: OS/26/2015
ORONO, MN 553 6-
952 249-4600 FAX: 95 249-4616
ADDRESS : 4360 BAYSIDE RD
PIN : 06-117-23-12-0001
LEGAL DESC : UNPLATTED 06 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL-MULTIPLE
VALUATION : $ 17,000.00
NOTE: GEOTHERMAL-2 HEATING SYSTEMS, 1 COOLING SYSTEM
APPLICANT MECHAN CAL 212.50
STATE S RCHARGE MECH(VALUATION) 8.50
UMR GEOTHERMAL MAIL-IN EE 2.00
5115 INDUSTRIAL STREET
MAPLE PLAIN,MN 55359 TOTAL 223.00
(763)479-6325 Payment( )
Minnesota State License#:mech-MB003275 CHECK 035597 223.00
OWNER
MAJOR,LYDIA&CHRIS
4360 BAYSIDE RD
MAPLE PLAIN,MN 55359-
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
requested in conformance with the State Building Code.This permit may be
revoked at any time fo�due cause.
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Applicant Permitee Signature Date ssu B Signature Date
FOR CITY USE ONLV"
City of Orono G
�O�O P.O.Box 66 Date Received: c�'—Ir`��Hermi[# `L�.S ��,�
2750 Kelley Parkway
Crystal Bay.MN 55323 Approve�i By: ��� Amount$: ��� ��
Phone(952)249-4600 Fax(952)249-4616
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�qk��HQ�E,� CITY OF ORONO— ECHANICAL PERMIT
(All Commeroial permrts must be approved by e Building OPficial or Inspector and/or Fire Marshall)
GENERAL INFORMATION �
l. You may apply for mechanical permits by mail or in erson at the City offices. Applications will
be reviewed and a permit will be issued within two w rking days.
2. Permit cards will be sent by return mail after a revie is completed. PERMITS ARE NOT
VALID UNTIL YOU RECE[VE A PERM[T. WOR MUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON THE JOB SITE
3. Mechanical Designs—Complete calculations,details nd specifications are required for each
heating,ventilation,humidification-dehumidification,and air conditioning installation including
heat loss/heat gain calculation,design temperatures,e uipment ratings and identification as to
type, manufacturer and model. Data shall be present on form provided.
4. When any new construction or remodeling is involve ,a separate building permit must be
obtained.
5. All work must be done in accordance with the Unifo 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 Record must be submitted before final.
TYPE OF PER T
Check All That A 1 )
❑■ Residential ❑ Commercial(Approval Required)
❑ New ❑ Additional ❑ Rep irs �Replace
Job Site/ Owner Information:
s�te aadress: 4360 Bayside Road
oWner: Lydia & Chris Major Mailin Address: 4360 Bayside Road
clty: Orono 55359
Zip:
Home Phone: 6� 2-5H� -OHSO Alterna e Phone:
Contractor Information:
UMR Geothermal, �n�. Sara Natins
Contractor: Contac Person:
Address: 5115 Industrial St State B na #: MB003275
City: Maple Plain Zip. 55359 Expirat on Date: 09���ZO� 'rJ
Phone: (763� 47J-C�325 Alterna e Phone:
0 Insuran e—Current: 9/1 /1 5
1
MECHANICAL SYSTEMS�BE NG INSTALLED
Note: All Geothermal Systems will now require a Site P an & Review by our Building Official.
[S THIS GEOTHERMAL? 0 Yes ❑ No
HEATING SYSTEMS
Quantity: �
Make: ,1c t,t3l4Kf'ht/"i�ict
Model: �9j(,� �f�.1rQ`�OCks 1� Q�
Fuel: ��o p�}�:C
Flue Size: � � 3�,�✓C
Input BTUs: ��� ��� p
Output BTUs: ��� ���
CFM: 'l0 Q�
COOLING SYSTEMS
Quantity: �
Make: �14-'�-�'�c.�i•ar
Model: N��" Oy �
Tons:
H. Power
FIREPLACES
Gas Factory Fireplace rand Name:
Wood Burning Fireplace
Wood Stove odel No.:
Wood Stove with Flue/Masonry
VENTILATION
No. Kitchen Exhaust d ct recirculating cfm
No. Bath Exhaust(must havelduct outside) cfm
No. Other Fans: Locations cfin
FUEL STORAGE (Must be approved by Fire Murshull ifpr posing to ahandon tank in place.)
❑ [nstallation ❑ Removal
Fuel Oil: gallons Underground ❑ [nside ❑ Outside
LP Gas: gallons
Other:
GAS LINE ONLY
� Outdoor Grill � Other/List What Where:
2
PERMIT FEE CALCU ATION(S)
BASED OFF -2002 STA E STATUE
❑ Yes,this section applies
The replacement of a Residential fixture or appliance that me ts all three of the following requirements:
1. Does not require modification to electrical or ga service.
2. Has a total cost of$500.00 or less;excludin�th cost of the fixture or appliance: and
3. Is improved, installed or replaced by the homeo ner or licensed contractor.
Skip next section, if this applies; Cost of ermit $ 15.00
State S charge $ 5.00
Mail-[n ee(If Applicable) $ 2.00
Total P rmit Fee $
PERMIT FEE CALCULATIOIV S JOBS OVER$500.00
ff above does not apply;follow guidelines below:
1. CONTRACT PRICE * is 1.25%of contract pr ce with a(Minimum Fee of$50.00)
17000 X .o�2s $ 212.50
(contract pricc (minimum 550.00)
2. STATE SURCHARGE �7000 H.�JO
x.0005 $
(con[ract pric
3. POSTAGE&HANDLING(Only on Mail-[n App ications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $223.00
■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
permitted work including materials, labor, profit, anc� oth r fixed costs. [t is the amount to be charged
to the customer for the work done. If any material, equi ment, labor or installations are furnished by
the owner, tenant or any other party, the reasonable mar et value of such items must be added to the
estimated cost or contract price for permit fee purposes. [n the event that there is a dispute on the
amount of the job cost, the City may request the submis ion of a signed copy of the actual contract.
MECHANICAL PERMIT APPLIC TION AGREEMENT
The undersigned hereby applies to the City for issuance f a Mechanical Permit, agrees to do all
work ii� strict accordance with the ordinances of the ity and the regulations of the State of
Minnesota, and certifies that all statements made on his application are complete, true and
correct.
Applicant's Signature: ' Date: � �
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