HomeMy WebLinkAbout2011-01501 - gas fireplace � CITY OF ORONO PERMIT NO.: 2011-01501
i 2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE IssuED: 12/OU2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 1635 BOHNS POINT RD
PIN : 17-117-23-11-0006
LEGAL DESC : REG. LAND SURVEY NO. 0565
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIREPLACE-GAS
VAWATION : $ 8,000.00
NO"I'E: H-N-G RED 60 GAS FP
APPLICANT MECHANICAL 100.00
FIRES[DE HEARTH&HOME STATE SURCHARGE MECH(VALUATION) 4.00
2700 FAIRVIEW AVE
ROSEVILLE, MN 55113 MAIL-IN FEE 3.00
(651)633-2561 MISC FEE 0.00
Minnesota State License#: 20512060 TOTAL ]07.00
OWNER
KOZLAK, STNICK&JODEE
1635 BOHNS PT 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
permi[s. All provisions of laws and ordinances governing this type of work
shall be compicd with whether or no[specified herein.This permit will
expire and bccome null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if cons[ruction is
suspended for a period of l80 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with lhe State Building Code.This permi[may be
revoked at any time for due cause.
`'�vt1.t-�� W`' / /
Applicant Permitee Signature Date � �
Issued By i nature ate
SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
FOR CITY L1SE ONLY
f�"'0"��, City of Orono
��04 �O\�� P.O.Box 66 Date Received: Permit#
� �., y; 2750 Kelley Padcway
� C stal Ba MN 55323 A roved B Amount$:
11k� , ,': rY Y, PP Y�
ti� ux� r,o�%� Phone(952)249-4600 Fax(952)249-4616
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CITY OF ORONO—MECHANICAL PERMIT
(All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall)
GENERAL INFORMATION
1. You may apply for mechanical permits by mail or in person at the City offices. Applications will
be reviewed and a permit will be issued within two working days.
2. Permit 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 UNTIL THE
PERMIT CARD [S POSTED ON THE JOB SITE.
3. Mechanical Designs—Complete calculations,details and specifications are required for each
heating,ventilation,humidification-dehumidification,and air conditioning installation including
heat loss/heat gain calculation,design temperatures,equipment ratings and identification as to
type,mar.ufacturer and model. l�ata shall be presented on form provided.
4. When any new construction or remodeling is involved,a separate building permit must be
obtained.
5. All work must be done in accordance with the Uniform 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 PERMIT
Check All That A 1 )
�Residential ❑Commercial(Approval Required)
�New ❑Additional ❑ Repairs ❑ Replace
Job Site /Owner Information:
Site Address: �3 �i! _��►�,Q �L}*�J� ��vt�
�
Owner: .��� �� Mailing Address:
City: ��� /�•t,n.�,vu,�.. zip: 5'�i i-/3 7
Home Phone:�S�z ,5!3?- h 3 3� Alternate Phone:
Contractor Information:
Contractor: Contact Person:
�'�%i�.:� ,,� , „ OGIES, IN�.
dba �-IRESID� HEARTH & HOME
Address: State Bond#: a
z700 FAIRVIEW AVENUE N
City: Zip: Expiration Date: ROSEVI��E, MN SS113
651.633.2562
Phone: Alternate Phone:
❑ Insurance—Current:
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' ` MECHANICAL SYSTEMS BE�NG INSTALLED
Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS THIS GEOTHERMAL? ❑ Yes ❑No
HEATING SYSTEMS
Quantity:
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H.Power
FIREPLACES
� Gas Factory Fireplace Brand Name: �'—M'�
❑ Wood Burning Fireplace
❑ Wood Stove Model No.: � (,�(�.
❑ Wood Stove with Flue/Masonry
VENTILATION
❑ No. Kitchen Exhaust duct recirculating cfm
❑ No. Bath Exhaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfm
FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.)
❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside
LP Gas: gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill ❑ Other/List What&Where:
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� � PERMIT FEE CALCULATI�N(S)
BASED OFF - 2002 STATE STATUE �
❑ Yes,this section applies
The replacement of a Residential fixture or appliance that meets all three of the following requirements:
1. Does not require modification to electrical or gas service.
2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance: and
3. Is improved,installed or replaced by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $
PER.I�'��EE GALC�ILATION(S)—J4BS OVER$SU0.00 —�
If above does not apply;follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
� G'�G��� L'�G> x.0125$ � CLr'.G'U>
(conuact price) (minimum$50.00)
2. STATE SURCHARGE
�UC�L�_ G�G� x.0005 $ S�G�'
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ I�7 �v
■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
permitted 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 owner, tenant or any other party, the reasonable market value of such items must be added to the
estimated cost or contract price for permit 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 actual contract.
MECHANICAL PERMIT APPLICATION AGREEIVIENT
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 complete, true and
correct.
Applicant's Signature: /���`'i� `� Date: � l�������
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