HomeMy WebLinkAbout2012-00757 (mechanical-furnace & AC) , ' CITY OF ORONO * z 0 1 2 - 0 0 7 5 7 *
2750 KELLEY PARKWAY UATE ISSUED: 08/03/2012
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2691 CAROLINE AVE
PIN : 20-117-23-24-0025
LEGAL DESC : REG. LAND SURVEY NO. 0115
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHAMCAL-MULTIPLE
VALUATION : $ 7,750.00
NOTE: 1 LENNOX NG FURNACE
1 LENNOX 2.5 TON AC
APPLICANT MECHANICAL 96.88
GOLDEN VALLEY HEATING&AIR STATE SURCHARGE MECH (VALUATION) 3.88
5182 WEST BROADWAY
CRYSTAL, MN 55429- MAIL-IN FEE 2.p�
(612)535-2000 MISC FEE 0.00
TOTAL 102.77
OWNER
PULVER, THELMA
2691 CAROLINE AVE
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
Thc work for which this permit is issued shall be performed according to
the approved plans and specifieations,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 separatc
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 I 80 days oP the date of issuance,or if construction is
suspended tbr 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 a[any time for due cause. '
��'►ti� �' l l ll-�-a.-„�__ l l
Applicant Permitee Signature Date Issued E3y Si ature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED ABOVE.
FOR c�T��usN:on�i.v
City of Orono
���� I'U.�����(, Date Received: P�rmit#
� ` 27>0 Kellc��Pnrk�+a�� -- -- --
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�� ?Y�'� `; Cnstal E�a�.MN�;3?i ApProved By: ilmount$ --
� t}�r, Phonr(952)249--1600 Fas(9�?)'-19-1616
�sexo�'� —
CITY OF ORONO-MECHANICAL PERMIT
(AII Commercial pcnnits must be approved hy the Buildine Of�ticial or Inspector and/or Pire Marshnll)
GENERAL INFORMATION
1. �'ou may apply�for mechanical permits by mail or in person at the City offices. Applications�tiill
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
��ALID CNT1L Y'OU RECEIVE A PERMIT. WORK MUST NOT BEGIN ��NTII �CHE
PER,bi1T CARD IS POSTED ON THE JOB SIT'G.
;. !vlechanical Desiens—Complete calculations,details and specifications are required for each
heating,ventilation,humidification-dehumidification,and air conditioning installation includin��
heat loss/heat gain calculation,desi�n temperatures,equipment ratings and identification as to
t��pe,manufhcnirer and���odel. Data shall be pre,e�;ced oi�fo�m pro•,-;ded.
4. When any new construction or remodeling is im�olved,a separate building permit must be
obtained.
5. All work must be done in accordance with the Uniform Mechanical Code/State[3uildin«Code
requirements.
6. All work must be inspected(rough-in and final). Call(952)249-4600.
(24-�8 hour notice required)
7. House Heatine Test ftecord must be submitted before final.
TYPE OF PERMIT
(Check All That Apply}
�esidential ❑ Commercial(,4pproval Required)
❑ New ❑ Additional ❑ Repairs `�Replace
� \
Job Site/Owner Information: --�
a , y�
Site Address: vl �� ! �(,��1-G�e,' �,��..P�
Owner: (�t--( '` L �G� V�V" Mailing Address:
��� � �1�C��('r'����a�p �/
Ci ����C�.z�-� ��4��.k,�-� C�L�({ �i�
City: 7ip:
��,�, 'fJ��w�`�� -
Ho�ne Phone: _ Alternate Phone:
Contractor Information: �
Coi�tractor: (R INCCo��tact Person: _
5182 WES':' BROAD`:dAY
Address: _�Ry��Tq, MN �5429 State Bond #:
763-535-2000
City: Zip: Expiration Date:
Phone: Alternate Phone:
❑ Insurance-Current:
� — -
MECHANICAL SYSTEMS BEING INSTALLED
Note: All Geothermal Systems ���ill now require a Site Plan & Review by our Building Ofticial.
IS THIS GEOTHERMAL? ❑ Yes �No
HEATING Sl'STEMS
Quantity: �
T _
N1ake: �����'�
;�1ode1: � � ���k(,'�jG�� --- - --
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING Sl"STEMS
Quantity: �
Make: �,l�l I�l� �----
Model: ly�W_��j�)
Tons: ��� _ __
H. Power
FtREPLACES
❑ Gas Factory Fireplace Brand Name:
-- - -------
❑ �'ood Burnine Fireplace
❑ Wood Stove Model No.:
-- _-- ---- -
�Vood Stove with Flue i Masonry
VENTtLAT10N
❑ No. Kitchen Exhaust duct recirculatii��, ctni
❑ No. _ Bath Exhaust(must have duct outside) cfi�i
❑ No. Other Fans: Locations cfm
FUEL STORAGE (Must be npproved hti�Fire Mnrshnl/if proposfng!o abnndo�t trr�7k in pl�rce)
❑ Installation ❑ Removal
Fuel Oil: __ gallons ❑ lJnderground ❑ Inside ❑ Outside
LP Gas: gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill ❑ Other/List W'hat& Where:
2
PERMIT�FEE CALCULATION(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 requiremenis:
I. Does not require modification to electrical or gas service.
? Has a total cost of$500.00 or less;excludin�tl�e cost of the fixture or appliai�ce: and
3. Is improved. installed or replaced by the homeowner or licensed contractor.
Skip ne�t section, if this applies; Cost of Permit S I�.00
State Surcharge $ �.00
Mail-In Fee(IfApplicable) $ �.00
Total Permit Fee �
�_ PERMIT FEE CALCU�LATION�S}-JpBS OVER $500.00 --�
If above does not apply; fo(low�uidelines below:
L CONTRACT PRICE * is 1.25°%of contract price with a(Minimum Fee of 5.50.00)
17J�. ��� �; .o��s � ---��_� � �
(con[ract price) (minimum SS0.011)
'_. STA'CE SURCHARGE � �� �, '��j �j
— �----x .0005 $ _V.� �/_ —
(contract pricc)
3. POST.AGE 8� HANDLING(Only on Mail-ln Applications) $ �.p0
4. TOTAL PERMIT FEE(Add Lines I-3 Above) $ � �'��i .
' * CONTRACT PR10E or JOB COST means the actual or estimated dollar amount charged for the
permitted work including materials, labor, profit, and other fised costs. It is the amount to be char��ed
to the customer for the work done. If any material, equipment, labor or installations are fui7�ished b�
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 thc
amount of the job cost, the City may request the submission of a signed copy of the actual contract.
�� � � MECHANICAL�PERMIT APPLICATION AGRE_EMENT —�
The undersigned hereby applies to the City for issuance of a Mechanicai Permit. a��rees to do all
�vork in strict accordance with the ordinances of the City and the regulations of� the State of�
Minnesota, and certities that all statements made on this appiication are complete, true and
correct.
� �
�
Applicant's Signature: Date: � ��i-
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