HomeMy WebLinkAbout2015-01474 (mechanical-furnace) ' CITY OF ORONO * z 0 1 5 - 0 1 4 7 4 *
2750 KELLEY PARKWAY DATE ISSUED: 1U18/2015
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 : HEATING SYSTEMS
VALUATION : $ 2,500.00
NOTE: (1)LENNOX NATURAL GAS FURNACE
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 1.25
GOLDEN VALLEY HEATING&AIR MAIL-IN FEE 2.00
5182 WEST BROADWAY
CRYSTAL, MN 55429- TOTAL 53.25
(612)535-2000 Payment(s)
CREDIT CARD 7420 53.25
OWNER
PULVER,THELMA
2691 CAROLINE AVE
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 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 Sta[e Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Iss ed � ignature Date
11/17/2015 16:49 7635354379 GOLDEN VALLEY HTG PAGE 01/04
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� �oz�cr�use oNc,v
/,���J� C�ty of Orono
/ �y P.O.Box 66 Dace�eceived: Pem,it#
�750 Kelley Park�vay
Cryscal8ay,MN 553z3 App�ovcd Sy: Amount$:
Phone(952)2q9-4600 Fax(9S2)249-461 C `
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���kFs����.�, C�'�'Y OF Q�ONO—1V.iEC�.ANICA,L PERM�'I'
(All Commercial permits must be approvcd by the Building Officia3 or Inspccror and/or Pirc Ma�shalt)
GENER.AL INFORMATZON
l. You may apply For mec�anical pem�.its by mail or iu�exson at the City offices. Applicatior�s wi�l
be reviewed and a�e�x►it wi11 be issued within two working days.
2. �eYmit cards will be sent by Xetum mail aftetr a rsview is complcted. P��MITS,A„R�NOT
VAJ.�UIVTLL YQLJ�LECE,IVE A,p$RMIT. WpRK MUST�iOT BEGIN UPITIL T,f�F,
P�RIV �CARD IS POSTEb ON TAE J'OB SI'�F_
3. �ecl�anical Designs—Completa calculatio►is,detail5 and speci�cations are reqt�ired for eac�,
hcating,ve�tilation,hu�idi�cation-dehuznidification,and au�conditioning installataom including
heat loss/heat gai,t�calculation,desigrt tcmperatures, equipmez�t xatings and ider�tification as to
typc,manuFacturcr and mvdel. Data shala be preser,ted on form prov�ded.
4, Whe� at�y ncw canstructiott or re��odetitlg is involved,a separate building pannit rxaust be
obtained.
5. All work musc be done ir�accordance with the Uniform iV�echanical Code/State BuilBing Code
rcquireme�nts.
6. All work must be inspected(rough-in and�nal). Ca11(952)24913b00.
(z4-48 hour not�c�required)
7. House Heating Tcst Record rriust be submitted be�ore final.
TXPE OF PERMIT
C�ec�Al1 Tlaat A, 1
[�Residential ❑Commercial(Approval Required)
❑New ❑Additioz�al ❑Repairs �eplace
Job Site/Owner Infozxzaation:
Site Add�ress: �p- 1 ��� �� (/tQ(/��t.�
Owner: Cz J Y L�. Maili�zg Address: E� �7 ��Q ,'Q(,� L /�2.1✓
City: ��1 �,cn v �� �'Q� �ip: _ � � �-�`7✓�
Hoine Phox�e: �� 0� - � C �' C� �� �r�e�ate phone: _
Contractoz��nfonnaxio�:
Cozxtractor: Contact Ferson:
G. . C.
Address: 5i�����aADVUAY State Svnd#:
78�--535-2000
CirY: Zip: E��ira:tioz�Date:
Phone: Alternate �k�oz�e:
❑ Insw-ax�ce—Current:
Z
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_ � ;
MEC�4NrGAT.,S�''�TEIt��B�ING�iST�i.L,L�D
Noke:All Geothennal Systerns wil�now requxxe a Site a &Review by our Bualding Officaa�_
IS TH�S GEOTHE�tMAL? [] Yes ��Io
HEATI�V'G SXSTEMS
Quantity: I
Make: L��x
Model: Vt� _ —
FueI: (X.4.�
Fiue Size:
Input�'�'ITs: I/C� )
o�,r��c B7vs_ � f 0
CFM:
COO�ING SYSTEMS
Qua�tAty:
IVYa,ke:
Model:
T'ons:
H_PoWer
FIREPLACES
❑ Gas Factory Fizeplace Brand Name:
[] Wood Burning Fireplace
❑ Wood Stove Mode�No,:
❑ Wood Stovc with Flue/Masonry
VFN"T'1LATION
❑ No_ _, Kitcher��xhausf duct recirculating cfm
� No. �ath Exhaust(must hflve duct outszde) cfm
Nq. Other�ans: LOCations cfrrl
���,ST�RAGE (Must be approved by Frre Marshal(if,�ro,posi�rg tv abando►i tank in place.)
❑ Insta�lat�oz� ❑ Removal
Fuel Oil: gallor�s ❑ U�ndergcound �lnszde ❑Outside
�,P Gas: galions
Otb�er:
GAS L1N�ONLY
❑ Outdoor Grill [] Othcr/�.ist What&Whcrc:
2
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' PE�,Iv11"r,.�`Fs�Gt�,�TJLA'��QN(5) ;• � .
�$ASEl7 0�"�''�-2D02,,�`t'ATE�T.�4'�'L?E '
❑ Yes,thas section appl�es
�'he rcptaceznent of a Resideptial fixture or� li�p ance that meets all three of the following requirements-
1_ oes not rcquire modi�icatio�z to eleccrical or gas service.
2. Has a totai cost of�SOOAO or less;excludin�the cost of the£ixtuxe or applia�ce:and
3. Is improvcd,installed or replaced by tk�e homeowner or licensed eo�tractor.
Skip next sectxon,if this applies; Cost of Permit $ 15_00
State Su�c�,arge $ �.00
Mail-�n Fce(IfA�p]icabl�) $ Z.00
Total Perroit kee $
"' �'ERMT'X?���CPiI,�C�'X;ATIOh1 S --��►BS"O� , '$5�0.0!0 .
If above does not a�ply;follow guidelines below:
1_ CONTRAC'f' Zt�CE * is 1.ZS%of contract price with a(Mininxum Fee ot�50.00)
_ ��d�• � x .Q125� � U
(cantract price) (minimu�550.00)
2. S'�ATE SU RGE r� � �j
V y x.0005 � ( � �.J
(contract pt7ice)
3. �OSTAGE&HANDLING(Oz�ly on Mai[-In A,pplications) $ .�.g�
4. �'OTAL P��IT FEE(Adcl I.ines I-3 Above) � C ��
■ � CQN�'�,ACT PRrCE or JOB COST tttearts the actual or estimated dollar amount charged for the
pet-mitted work including materials,labor,profit, and other fixed costs. �t is the amount to bc charged
to Ihe customer�'or chc work dope. zf ar�y material, equipment, labor or installations are fumisiied by
the owner, tenant or any 4ther pa�ty, the reasonable rrtarket value o�such items must be added to the
estimated cost or contract �rice for permit fee purposes. In the event that tl�ere is a dispute on thc
amount of the job eost, the City may request the siibmission of a signcd co�y of the act�,al contract.
', ,',�" ME�k�ANZGAL PER�'� Q.�'�LICAT�ON AG��1I�IET�IT '
T�te undersigned�aereby a�pl�es to the Ciry :for issuance o�a Meehanical �ezxnit, agrees to do ala
work in straet accordance with the ot•diz�az�ces of the Cxry a�nd the regulatao�s of the State of
Minnesvta, and certifies that alE statexne�ts �nade on this application are complete, true and
correct.
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Applicant's Signatuze: �&t�;
3