HomeMy WebLinkAbout1985-7789 - conversion burner GENER�L PERMIT CITYPERMITNO. ���9
CITY OF ORONO
r.O.EOX 66 Date � �'��
CRYSTAL BAY, MINNESOTA 55323
(612)473-7357 �
Owner ./'� � �—'"�[5����';1 ° I��- �� Address � l`\-� �% �/"C'��,�_�; �7'L.��
Contractor � �� /� • li���� �C'��2��/'�(� Address ��� �`E'C-'�L.�li/��o( K5' / �. (�
City License No. � �_��/ �C State License No.
/
REMARKS AND SPECIAL CONDITIONS
_�� �-G-���� ��4�,r`� ir�ri� .c�t-.�'�
PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION �BEPAIR
Inside Plumbing (#fixtures_) Fee $ Water Well Fee $
Water Meter (Size) Fee $ Mechanical Equipment Fee $ �fl�
Meter#
Remote;� Moving �Lifting Buildings Fee $
Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $
� Grading, Filling, etc.)
❑Copper
Municipal Sewer Connection Fee $ — _
Fire Fee $
❑ PVC ❑Cast n Sprinkler System (Fire) Fee $
MWCC SAC Charge Fee $ Other: Fee $
On Site Septic System Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited
pexmit, including acceptance of all special information,
terms, conditions or requirements written above. The � t—��
undersigned understands and a�ees under penalty of law State Surcharge: Fee $�,j�_
that this permit is strictly limited in scope to the work,
activity or unprovement specified; that this permit does --� �l
not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ �� � �V
sepazate permit approvals; and that this permit does not
grant authority to violate any provision of any City
ordinance or State law,rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
�oaes and/or he�cn department regulations, and sneu be This permit is not valid until the proper fee is paid and
subiect to inspection, approval or reiection by the City. lt 1S 7 roved b an authorized Cit Official.
Whenever so ordered, the undersigned agrees to correct pp Y Y
any work found to be in violation of the conditions of
this permit.
Signa�k�rre�f� lican Signa ure of City fficial
''�— � C'�,�`�
Code:White—Pile Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanYs Receipt
CITY OF ORONO
APPLICATION FOR MECAANICAL PERMIT
GENERAL INFORMATION
l . You may appl� for n�echanical permits by mai. ] or in person at the City
offices. riailed-in permits are subject to the pestage and handling
fees shown below.
2 . Permit= cards wiil. be sert by return mail t.he same day the application
is received. PERr'�ITS ARE NOT VAI�ID UNTIL YOL' RECF'IV� A PERMIT. WORK
MUST NOT BEGIN UI�TIL THE PERr1IT CARD IS POSTED ON THE JOB SITF.
3 . When any new construction or remodeling is involved , a separate
building pern-�it must be obtained .
� . All work must be done in accordance with State Luilding Code
requi remel�ts.
� . Al1 work must be inspected (reugh-in and final ). Call 473-7357. 24-
hour notice required .
6 . House Heating Test Record �rust be submitted before final.
INSTRUCTIONS Complete all items on this application. Compute the permit
�ee. Sign anci date the certificatien. Ii�COMPLETE AFPLICATIONS �ti'ILL NOT BE
PROCESSED. If you have questions , call 473-7357 .
;•:ALK-IN PER1�iI7'S apply at City Offi.ces, 1335 South brown Road (Cty. Rd 146 )
:.AIL-II� PFRMITS encicse fee - N,ail to: P. O. fiox 66 , Crystal Bay, MN 55323
�*t********�:* ** ***�t***********�*********��:*********************************
�OB SITE ,�SOC /Sf�i�C,�f�S' /'� �I��
Cwr.�er ' s Name r, �c ati ���� /� Telephone Number
'•:ailing Address S"�: / /��k�� 7S 7 / �
Contractor ' s Name �_"� �c�-S Sr[���cE Telephone umber ,3 -.r`l1�
'•:ailing Address �C� �t � 1, cr� n f��l� f�p/��� ��C�'y '"S SI.�Zy
x*********** **�. *************#********************* ***�t* ***� ************* *
:'INIMUAI FEE ( $25 . 00 per project)
***********�*************************************�**************t********� *
HEATING SYSTEMS $20 . 00 each unit
FUEL � nat . gas , lp gas , oil , elect . � �;Z c-�-��,�,t ',�
other (specify if combination burner )
EQUIP. ( if mor.e than 1 unit per bldg. list each separately ) �G`"-C-`�C� /5 CG
NO. TYPE BTUH IMPUT BRAND NAME MODEL N0. �?Gcc�-��� ��f�'��
f .a . furnace
hw bo i 1 e r ���j j ��,c; 7`
unit heater
� C'G<<�/�as,��, ��2k<2s da.�� !� A��s — �� aa �G�-.� /y�'
solar htg. ���-���5 ��
equipment
Solar Equipment $50 . 00 each system Total
******************************************************� ****�;************�**
HOUSE HEATING TEST RECORD Q�Jv� �
ADDRESS _ / `��''� l7l�t�CGF� � Y � ��iAPT. FLOOR�---CITY SUBURB
OCCUPANT �� � ����"� � OWNER �� ���
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY �'� 1 ��-� f%��� «-
Electrical Work By Gas Line By – �'/ �'�
TYPE OF HEAT GA FA HW�STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN r'� CONVERSION
MAKE MAKE OF BURNER ��/f �
Model Model
$erial Max. BTU Rating �
INPUT MAKE OF FURNACE k�<���
Model 5 �
j���� CONTROLS //
THERMOSTAT--l�1— Heat Plug � Vent Size ,
Valve L S �- � KIND OF LINER v�'�9 SIZE� NONE
Limit ���Vj.�� Draft Hood Regularor �.�T`�
Limit Setting j!� Filters Size Nu ber
Fan Setting '��� Chimney Location Inside Outs�j�'
Pilot Type � Q�'< < � 0/� f�.- Chimney Construction ��iC� ''� i��ti
Pilot Make � t
Pilot Model �°��' l— ���
� $moke Bomb Wiring
Pilot Timing C Sh< Draft � Test Tag �
L.W. Cut Off �� Door Pressure Lighting Inst. ��
�
Pressure Percent CO2 / Date Tested " � '
Input CFH � Percent 02 �7� Company Testing ,=_ , f F"
$tack Temp. ���' Percent CO ���� Name of Tester � F-
Form 235