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� ' 2750 KELLEY PARKWAY pATE 1ssuEn: 10/27/2014
ORONO, MN 5�356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 110 CHEVY CHASE DR
PIIV : 36-118-23-41-0046
LEGAL DESC : HILL O'WAY MANOR
: LOT 012 BLOCK 002
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : HEATING SYSTEMS
VALUATION : $ 10,899.00
NOTE: BRYANT HEATING&AIR
APPLICANT MECHANICAL 136.24
STATE SURCHARGE MECH(VALUATION) 5.45
PRONTO HEATING&AC MAIL-IN FEE 2.00
7588 WASHINGTON AVE S
EDEN PRAIWE,MN 55346- TOTAL 143.69
(952)835-7777 Payment(s)
CHECK 143.69 143.69
OWNER
HIGGINS, KENNETH&LAURA
]]0 CHEVY CHASE DR
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 rela[ed 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 afrer 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 anv time for due cause.
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Applicant Permitee Signature Date Issued f Signature Date
f
�lty Of UI�(�f1U
2750 Kelley Parkway
Orono MN 55356 952-249-4600
Receipt No: 3.012111 Oct 27, 2014
Pronto Heatiny
Previous Balance. '���
Permits 136.?4
P2014-01250 110 chevy
chase
101-32530
Mechanical/Septic/Other
Permits ,.45
P2014-01250 110 chevy
chase
101-20802
Due to govts-State
Fermits � ��
p2014-01250 110 chevy
chase
101-34440
Bltlg Permits-mail in fees
Total: 143.69
Check
Check No: 9593 1�13.69
Payor:
Pranto Heating
T�ta1 Applied: 1A3.69
Change Tendered: ���
10/27/2014 U9:OlAM
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� U CT Z�2 U�� FOR CITY USE ONLY
� A�� City of Orono
/ �-�l y P.O.Box 66 Datc Reccived: Pcrmit#
� O 2750 Kelley Parkway �-��; :�,.-_ r -� `�- �"c
� 'y Crystal Bay,MN 5532�' � ` �" ` ` Approved By: Amount$:
f Phone(952)249-4600 Fax(952)249-4616
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�-,kESH��� ' 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 RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical DesiQns—Complete calculations,details and specifications are required for each
heating,ventilation,humidification-dehumidification,and air conditioning installation including
heat loss/heat gain calculation,clesign temperatures,equipment ratings and identification as to
type,manufacturer 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 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 )
�sidential ❑Commercial(Approval Required)
❑ New ❑Additional ❑Repairs eplace
Job Site/Owner Information:
e
Site Address: / � � h � � ` �� � J C �_
Owner: Ci �t r� r�� " Mailing Address: � �
���,: Z�p: s S� 9 /
Home Phone: ��I o� ' U G� ' ��y / S Alternate Phone:
Contractor Information:
Contractor: �/�a n i D � �p�/" Contact Person: � �'" �
Address: 7.��/b W RJ�� t°� �� State Bond#: M � a G �� ��
City: E ��^ f'x� ^'` Zip: $$3`-�NExpiration Date:
Phone: �S� �3� 7 � �� Alternate Phone:
❑ Insurance—Current:
1
MECHANICAL SYSTEMS BEING INSTALLED
Note: All Geothermal Systems will now require a Site Plan& Review by our Building Official.
IS THIS GEOTHERMAL? ❑ Yes �10
/
HEATING SYSTEMS
Quantity: �
Make: B Ip �/� �✓ T
Model: � � 7l✓�� �/�-d `a �
Fuel: � � S
C �r
Flue Size: �
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity: /
Make: � '� y�'N T
Model: I `�(p �/� /� a ��
Tons: �• S
H.Power
FIREPLACES
❑ Gas Factory Fireplace Brand Name:
❑ Wood Burning Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Masonry
VENTILATION
❑ Na 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:
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 requirements:
1. Does not require modification to electrical or gas service.
2. Has a total cost of$500.00 or less;excludinQ the cost of the fixture or appliance:and
3. ls improved,installed or replaced by tbe homeowner or licensed contractor.
Skip next secrion,if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $
PERMIT FEE CALCULATION S -JOBS OVER$500.00
If above does not apply;follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
X .0�25 $ l,� �, a y
contract price) (minimum$50.00)
2. STATE SURCHARGE
Q x.0005 $ S � �
( on ract pricc)
3. POSTAGE&HANDLING(Only on Mail-in Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ (
■ * 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 fumished by
tbe 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 AGREEMENT
The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all
wark in strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies t at all state ents made on this application are complete, true and
correct.
Applicant's Signature: Date: V � 0 � /
3
�� ��� �
DATE TIME
CITY OF ORONO CALLED IN �� , �-
INSPECTION NOTIC , ��25D SCHEDULED /2--Z- _�:,��
PERMIT NO. COMPLETED
ADDRESS o-/
OWNER T LEPHONE NO. �°�-��0� �"
CONTRACTOR �
� DESCRIPTION /�l vl ti7�%'��
�
W ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
� ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVEfLANDS
�
Q ❑ FRAMING �MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNERIFIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� � FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
� O DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
� ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� ❑WORKSATISFACTORY:PROCEED �OJECTCOMPLEfE
W ❑CORRECT WORK 8 PROCEED �❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR WILL REfURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTIONREQUIRED.CAILTOARRANGEACCESS.
Cal1 for the next inspection 2a hours in advance. (J52� 249-4600
OwnerlContractor on site:
Inspector. `
White Copyllnspector's File Canary CopyfSite Notice