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Home My WebLink About2012-00148 - gas fireplace CITY OF ORONO * z 0 1 z - 0 0 1 4 8 * ; 2750 KELLEY PARKWAY DATE ISSUED: 02/22/2012 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 3095 CASCO POINT RD PIN : 20-117-23-34-0005 LEGAL DESC : REG. LAND SURVEY NO. 131 1 : LOT 000 BLOCK 000 PERMIT TYPE : MECHANICAL(>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : F[REPLACE-GAS VALUATION : $ 5,000.00 NOTE: 1 GAS FP-TOWN&COUNTRY 1 WOOD BURNING FP-HEAT AND GLO GAS LINE BY OT}IERS APPLICANT MECHANICAL 62.50 GLOW[NG HEARTH AND HOME STATE SURCHARGE MECH (VALUATION) 2.50 100 ELDORADO DRIVE JORDAN, MN 55352 MAIL-IN FEE 2.00 (952)495-2927 M[SC FEE 0.00 TOTAL 67.00 OWNER WHIPPLE, PHILLIP 3095 CASCO PT RD WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT I�he work for which this permit is issued shall be performcd accordind 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 hcrein.This permit will expire and become null and void if construction authorized is not commenced within I 80 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 for due cause. /� ��iti'(,Q-c�. Gt� ,..,� � � � � Applicanl Permitee Signature Date Issued B ature te Y� € SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO , FOR CITY tiSE ONLY ` • �;�� City of Orono �,,Q �;,,, P.O.Box 66 Date Received: Permit# ,i ,�,, t; 2750 Kelley Yarkway �� .'�' P�� Crystal Bay,MN 5�323 Approved By: Amount$: '� ��,� z�o�'��" Phone(952)249-4600 Fax(952)249-4616 �*�t�a�,, CITY OF ORONO-MECHANICAL PERMIT (All Commercial permits must be approved by the Building Ot7icial 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. PERM[TS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3. Mechanical Desi�—Complete calculations,details and specifications are required for each heating,ventilation,humidification-dehumidification,and air conditioning installation including heat lc,ss/heat gain calculation,design temperatures,equipment ratings and identification as to type, manuf'acturer and model. Data 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 fmal). 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: 1 Owner: I� I � � Mailing Address: '�� L i�l �- ��C , � City: � Zip: �� r- Home Phone: Alternate Phone: '�J,�i�(,� �(�7 � �� Contractor Information: Contractor: C-� �1, ' � �1'S"�,'t>ntact Person: �, l /C�-� Address: � Q State Bond #: � / 1��_Q City: � Zip��Expiration Date: Phone: - �lQ Alternate Phone:�f� � -�� Lr�Ct�-� � Insurance-Current: �� -- �� Z- 1 : , ' ' ��`:�� R ,��`�.`�C�C��'�� . � � s..,� , ; �� ,. �� _. � �` 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 �/ � �S �m Gas Factory Fireplac� Brand Name:T .�- �}�.�1� � Wood Burning Fireplac� ❑ Wood Stove Model No.:�-�S:3�e�a :��c�-T ❑ Wood Stove with Flue/Masonry VENTILATION ❑ No. Kitchen Exhaust duct recirculating cfin ❑ No. Bath Exhaust(must have duct outside) cfm ❑ No. Other Fans: Locations cfin FUEL STORAGE (Must be approved by Fire Marshal!if proposing to abandon tank in place.) ❑ Installation ❑ Removal Fuel Oil: gallons ❑ Underground ❑ Inside ❑ Outside LP Gas: ___ _gallons Other: GAS LINE ONLY �`I ��,.,� ❑ Outdoor Grill ❑ Other/List What&Where: 2 PERMIT FEE CALCULEITION(S) �� BAS�D OFF — ��OZ STATE�S"�'ATI�E ❑ 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. [s improved, installed or replaced by the homeowner or licensed contractor. Skip next section,ifthis applies; Cost of Permit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ ' PER11��T FEE CALCULA = �,.... � �� - � � �� ,�� _ �;,��.��U€}.Ot?� � .��. If above does not apply; follow guidelines below: 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of�50.00) 5(_.!�, C� X.�I 25 $ (�P � ��"C�J (contract price) (minimum�50.00) 2. STATE SURCHARGE -. �� (�U x.0005 $ ,/� � S� (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ LQ�. � ■ * CONTRACT PRICE or JOB COST means the actual or estimated dol!ar amount charbed 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. � : ,- ��3. »> ;�z...`��,'�ANI�AL'PERNIIT � ' � �„,,; �� : � a a�� .. , ... ... :.. �� 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 atl statements made on this application are complete, true and correct. Applicant's Signature: Date: � a'� �� Reset Form 3 Mirinesota,pepartment of Labor and Industry Licensing and Certification Services Cons�kuction Codes and Licensing Division Phone: 651.284.5034 443 Lafayette Road N Email: DLI.License@state.mn.us Saint Paul, MN 55155 Website: www.dli.mn.gov/ccld.asp NOTICES NOT TRANSFERABLE CHANGE YOUR BUSINESS STRUCTURE GLOWING HEARTH & HOME LLC SUBMIT A NEW APPLICATION FOR NEW ENTITY 100 �LDORADO DR RENEW OR REPLACE INSURANCE POLICY JORDAN, MN 55352 SUBMIT NEW CERTIFICATE OF INSURANCE / NOTIFY TH£ DEPARTMENT OF A CHANGE IN YOUR BUSINESS'. Failure to do so,subjects you to administrative penalties of up;to$7;0,000. 15-Day Notice Requirement—Forms available online at www.dli.mn.qov/CCLD/LicUpdate.asp • Change in business'physical address,mailing address,phone number,or email address • Change in control,owners,officers,directors,members,partners • Change in business"legal narrte anci/or assumed name • Loss of or change in RESPONSIBLE INDIVIDUAL • Change in general Iiability insurance or workers'compensation insurance coverage Immediate Notice Requirement—Notification to DLI in writing • Judgment Debtor.; A licensed contractor has 15 days to provide written notice of the finding that it is found to be a judgment debtor based upon conduct requiring licensure. • Bankruptcv Petition Filed: A licensed contractor has 15 days to provide written notice that it filed a petition for bankruptcy. • Conviction Notice. A licensed contractor has i 0 days to provide written notice that it has been found guilty of a felony,gross misdemeanor, misdemeanor or 'any. cumparable offense reiated to the license, inciuding conviciions �fi iraud, misrepresentation,misus�of funds'theft, criminal sexual conduct, assault, burglary, conversion of funds, or'theft of proceeds in this or any other state or any other United States jurisdiction. YOUR CERTIFICATE IS BELOW THE PERFORATION. 'SHOW CERTIFICATE WHEN OBTAINING PERMITS. � 'ti�� A11hFNE56T}I�EPARTMENT-:pF � �.� �{/�ECHANICAL CONTRACTOR �O��IVD �� LABOR �3c 1t�DUSTRY i�� . � .... . Construction Codes and LicensingDivision Licensing and Certification Services 443 Lafayette Road N St.Paul,MNb5155 Website: www.dli.mn.govtccld.asp Email: dli.licenseCa�state.mn.us Phone: 651.284'5034 This is to certify that the certificate holder is registered as a MECHANICAL CQNTRACTOR BOND in the state of Minnesota and is in compliance with Minnesota Statutes 326B.197,and has filed a$25,000 mechanical bond to peeform gas;heating,ventilation,cooling,air conditioning, fueI burning,or refrigeration work in all areas of the state during the registration period;provided the wark perfonned complies with the STate Mechanical Code and the certificate holder maintains compliance with the required bond and workers'compensation laws. Registration : MECHANICAL CONTRACTOR BpND ' � RegNumber : M6005786 � GLpWING HEARTH & HQME LLC e Effective Date : 02/16/201`2 :100 ELDORAQO DR � Expiration Date : 02/16/2014 JORDAN, MN`55352 � T ' VEI�IFY UP-TO-DA7E STATUS, BOND,AND INSURANCE INFO ATwww.dli.mn.qo�/cc[d/LicVerifv.asp (ENTER NUMBER). ,4co� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) ` ' io/la/zoii ..►.%" THIS RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-952-358-7500 CONTACT NAME: Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX A/C No Ext): NC No): 3600 American Boulevard west E•MAIL ADDRESS: Suite 500 — B100miRgtOn, MN 55431 INSURER(S)AFFORDING COVERAGE NAIC# _ _ __ . _. __ INSURERA: GENERAL CAS CO OF WI 24414 INSURED INSURER B: Glowing Hearth & Home, LLC AMDS, LLC INSURERC: 100 Eldorado Di'ive INSURER D: Jordan, MN 55352 INSURERE_ _ INSURER F: COVERAGES CERT�FIC,!!TF NUMSER' 23624141 REVISION NUlUIBFR: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR� ADDLrSUBR�— �OLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER � MMIDD/YYYY MMIDD/YYYY I LIMITS A GENERaL LIABILI7Y � �CCS0352176 i 10/22/1 10/22/12I EACH OCCURRENCE $ 1,000,000 X �DAMAGE TO RENTED - COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ Z.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMP/OP AGG $ 1,000,000 I X� POLICY PR� �—I LOC j I I I I $ A AUTOMOBILE LIABILITY CBA0352176 COMBINED SINGLE LIMIT I Ea accident $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ' —� SCHEDULED BODILY INJURY Per accident $ AUTOS � J AUTOS ' ( ) HIRED AUTOS � I NON-OWNED PROPERTY DAMAGE I AUTOS � Per accident $ $ A X I UMBRELLALIAB X OCCUR CCU0352176 10/22/1 10/22/12 EqCHOCCURRENCE $ 2,000,000 � EXCESS LIAB CLAIMS-MADE I I I_. ._ _—_._ _. . AGGREGATE $ 2,000,000 ' �I DED �I �� RETENTION$ I � $ WORKERS COMPENSATION 'I WC STATU- I OTH- A ANDEMPLOYERS'LIABILITY Y�N I�C0352176 10�22�1�1 10�22/12 X T IMIT � ANYPROPRIETOR/PARTNEWEXEWTNE I E.L.EACHACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED7 � N�A� �I I (MandatoryinNH) E.L.DISEASE-EAEMPLOYE $ 100,000 If yes,descnbe under ---- —---- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ 500,000 � I j � � DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Orono THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P 0 Box 66 AUTHORIZED REPRESENTATIVE 2750 Relley Parkway Cryatal Bay, l�T 55323-0000 �� `��✓ USA l� O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/OS) The ACORD name and logo are registered marks of ACORD bikiahatin �/� <G� DAT TIME � CITY OF ORONO CALLED IN � �� INSPECTION NOTICE � SCHEDULED ��'' /•�3� PERMIT N � COMPLETED ADDRESS C� OWNER T PHONE NO. � - 6 3 � CONTRACTOR — >; DESCRIPTION l� � �� L�� ❑ FOOTING ❑ PLUMBING F AL ❑ EXCAV/GRADING/ ING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J � PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEEf YOU:_YES_NO � COMMENTS: � W a � J O a � O � W � Q ti Z W � W � � ��ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Call forthe next inspection 24 hours in advance. �95Z� 249-4600 OwnerlContractor on sit : Inspector. White Copyllnspector's File Canary CopylSite Notice