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HomeMy WebLinkAbout2009-00704 - fuel storage , . � CITY OF ORONO PERMIT NO.: 2009-00�04 2750 KELLEY PARKWAY ORONO, MN 55356- DATE �SSUED: 10/2U2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 1500 BRACKETTS POINT RD PIN : 11-117-23-34-0001 LEGAL DESC : BRACKETTS POINT 2ND ADDITION : LOT 002 BLOCK 001 PERMIT TYPE : MECHANICAL(>$500) PROPERTY TYPE : RESIDENT[AL CONSTRUCTION TYPE : FUEL STORAGE VALUATION : $ 2,174.55 NOTE: INSTALLATION-DIESEL FUEL STORAGE APPLICANT MECHANICAL 50.00 PUMP&METER SERVICES STATE SURCHARGE MECH (VALUATION) 1.09 11303 EXCELSIOR BLVD. HOPKINS, MN 55343 TOTAL 51.09 (952)933-4800 OWNER PADDOCK, BRUCE 920 SHADY LA WAYZATA, AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to [he 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 addi[ional 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 State Building Code.This permit may be revoked at a y time for due cause. � /d , 2/,O 9' fD� �� �9 Applicant Perm ee Signature Date Issu y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � � FOR C��USE Oti[.Y A� City of Orono ��/�� � O4`�`rO P.O.Qox 66 Date Received�� �emiit#tr�t(J(/% D 2750 Kelley Parkway ,p r� .� �`''• ; Crystal Bay,MN 55323 Approved By: p: Q, Amount$: _ �t� '� `�. :. a (952)249-4600 � ��HO~4 �/NA'� /�V SI� ON� ' N� S t�. P(/�N CITY OF ORONO-MECHANICAL PERMIT /�T"�^' (All Commercial pennits must be approvcd by the Building Official or Inspector and/or Fire Marshall) GENERAL INFORMATION l. 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 Desiens—Complete calculations,details and specifications are required for each heating,ventilation,humidification-dehumidification,and air conditioning installation including heat loss/heat gain calculation,design 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 noNce 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: � SiteAddress: � �D�; ����c�C'.�L-�.� `t�r� ,r��-- t��� %� - � Owner: ,lJ �'�=c�_ `F �•-����CX._s� Mailing Address: 1 S�:�C- +'�r-���i���" i"c�,r�t (�,-_, � .�5 3�i I ciry: ;.;c, ` �-�c_ zip: ._ � 1 ,- , , Home Phone: �'�-� � � 1� -v���:j Alternate Phone: Contractor Information: � _ Contractor: r��-�r��47 " �"��'-������%�c<�_. Contact Person: ��r��_�.,���Y� �t--i-. Address: � � ����� tx����c Y ����:��- State�e�#: ��� lo��"1 City: ��Q���� Zip:.��:��,� Expiration Date: '`�/��3� :� !C�' Phone: �1'��3 13.3- `�/:�'���i� Alternate Phone: �� Insurance-Current: �-t-�-��-pc`�- 1 � . IVIEC�-IANtCAL SYSTEMS BEING INSTALLED 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 ❑ Gas Factory Fireplace Brand Name: ❑ Wood Burning Fireplace � Wood Stove Model No.: ❑ Wood Stove With Flue VENTILATION ❑ No. Kitchen Exhaust duct recirculating cfm ❑ No. Bath Exhaust(must have duct outside) cfm ❑ No. Other Fans: Locations cfm FUEL STORAGE (Must be upproved by Fire Marshall if proposing to ubandon tank in pluce.) � Installation a Removal Fuel Oil: gallons ❑ Underground �Inside �,Outside LP Gas: allons Other: �: ��c�� GAS LINE ONLY ❑ Outdoor Grill � Other/List What&Where: 2 . , � PERMIT FEE CALCULATION(S) BASED OFF -2002 STATE STATUE ❑ Yes,this section applies The repfacement of a Residential fixture or ap�liance 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. Is improved,installed or replaced by the homeowner or licensed contractor. Skip next section,if this applies; Cost of Permit $ 15.00 State Surcharge $ .50 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ PERMIT FEE CALCULATI4N S -ZOBS OVER $SQ0.00 If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) -l. i ��-j . ��:, X .o�2s$ 5t�� .cj� (contract price) (minimum$50.00) 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50) -��-1�( ,c�L x .0005 $ ) . �!�I (contract price) (minimum$ .50) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �l . C�1 ■ * 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 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. ■ **The STATE SURCHARGE is.0005 of the Building Department at(952)249-4600 for the price. MECHANICAL PERMIT AFPLICATIC?N AGREEMENT 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 all statements made on this application are complete, true and correct. Applicant's Signature: � ;_p_,�---- Date: 1p � ��-��� Reset Form 3 , , � DATE(MMIDDIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE lo�i2�2oo9 PRODUCER (952) 935-5551 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Gladwin Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 738 llth Avenue South AL7ER 7HE COVERAGE AFFORDED BY THE POLICIES BELOW. Ho kins MN 55343- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:WeSt@Y'ri National Mutual Pump and Meter Service INSURERB: 11303 EXC@1310Z' BIVC� INSURERC: INSURER D: Ho kins MN SS343— INSURERE: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICV EXPIRATION LTR INSRD TYFE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY LIMtTS A GENERALLIABILITY CPP0015252 03/O1/2009 03�01�2OZO EqCHOCCURRENCE 8 1�000�000 X COMMERCIAL GENERAL LIABILITY PREMISES�aEoccu�nce s 1 OO,OOO CLAIMS MADE �OCCUR � � � � MED EXP(M one person) S 5,000 PERSONAL&ADV INJURY S 1,OOO�OOO � � � � GENERAL AGGREGATE S 2,OOO,OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOP AGG s 2�OOO,OOO POLICY X JEC�T LOC � � � � A AUTOMOBIIELIABILITY CPP0015156 03/O1/2009 03�01/2OlO COMBINEDSINGLELIMIT X ANY AUTO (Ea accident) s 1,000,000 ALL OWNED AUTOS � � � � BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS � � � � BODILV INJURY N01�FOWNED AUTOS (Per aaident) $ � � � � PROPERTYDAMAGE (Per aaident) $ GARAGELIABILITY AUTOONLY-EAACCIDENT E ANY AUTO � � � � OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSNMBRELLALIABILITY UMB0010691 03/O1/2009 �3�01�2�10 EqCHOCCURRENCE S 4�0�0��0� X OCCUR �CLAIMS MADE AGGREGATE S 4,OOO,OOO S DEDUCTIBLE � � � � g X RETENTION $10,000 8 A WORKERSCOMPENSATIONAND WCV0010629 O3/O1/2009 O3/01�2O10 X TORYLIMITS �ETR EMPIOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 8 SOO�OOO OFFICER/MEMBER EXCLUDED? � � � � E.L.DISEASE-EA EMPLOYEE S 5OO,OOO It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT E 500,OOO OTHER � � / / � � � � � � � � DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROV�SIONS CERTIFICATE HOLDER CANCELLATION ( ) — (952) 249-4616 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOIDER NAMED TO THE LEFT,BUT C1 t17 OE� O2'OIlO FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. P.O. BOX 6 6 AUTHORIZED REPRESENTATIVE �:r� .�—��--- C stal Ba NID1 55323- ACORD 25(2001/08) O ACORD CORPORATION 1988 ����IN$025(0108)DS ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 ot 2 , , , IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 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Expires 4/3/2010 _ "-�'- •. , _ , _. /,: - = �� r�.t _ :.;, 1.. i `_ � _'-.•.. ;:., '' �� Address 11303 Excelsior Boulevard City Hopkins ��� "-==, . �;���� -� .,:� „� � ��, �;;;: � \;\„� � �, = ;;,s;,,,•. _, ,. : ��: -:=:• ::-.•. � ==- �� � -��� ���5j The company issued this certificate has met the requirements of Minnesota Rules ��� � �__:=:;: ''===" '') ,� , _ �. `==%:---- ���� � ,�� Chapter 7105, and is certified to perform underground stor�age tank work in the �� �::;,,. 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Please call when permit is ready and we will have someone pick it up. Thank you • Fueling Systems • Inventory Controls • Electronic Gauging • • Fiberglass Tanks& Piping • Self-Serv Equipment • • Compressors • Auto Lifts&Parts • � • Service Station Pumps • 1