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Home My WebLink About2014-00558 - gas line only � ! CITY OF ORONO * 2 0 1 4 - PJ PJ 5 5 8 * 2750 KCLLEY NARKWAY DATE ISSUED: 06/04/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRF,SS : 2650 COUN�RYSIDE DR W PIN : 04-117-23-12-0014 LEGAL DESC : OLD CRYSTAL BAY ROAD AUDN : LOT 006 BLOCK 002 PERMIT TYPE : MECHANICAL(> $500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : GAS LINE ONLY VALUATION : $ 1,900.00 NOTE: GASLI?�[:TO POOI,1II?n"Il?IZ AND I�IR►i"I�/1[3I,F, APPLICANT MECHANICAL 50.00 STATE SURCHARGE MECH (VALUATION) 0.95 ME'I�RO GAS INS'I'ALLERS TOTAL 50.95 685 141ST LANE N W Payment(s) ANDOVER, MN 55304 (763)754-7119 CHECK 14717 50.95 Minnesota State License#: mech-MB003162 OWNER JORGENSON, ROBERT 2650 COUNTRYSIDE DR W I,ONG LAKE, MN 55356 AGREEMENT AND SWORN STATEMENT l�he��ork for which this permit is issued shall be perfom�ed according to the approved plans and specifications,applicable City approvals,and the State Building Code. 'i'his pennit is for only the��ork descrihed and docs not�rant p�rmission for additional or related work which requires separate permits. AII provisions of laws and ordinances govcming this t}�pe of��ork shall be compied with whether or not specified hercin."I�his pennit will e�pire and become null and void if construction authurized is not commenced��ithin 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any timc aftcr work has commenced. The applicant is responsible tbr assurina all required inspcetions are requested in conformance with the State I3uilding Code.This permit may be revoked at am tim for d cau �. � � �� / � Ap cant Permitee Signature Date Issu� By Signature Date � , f� /7 . FOR CITY USE ONLY " �O A TO City of Orono �y P.O.Box 66 Date Received: Permit# 2750 Kelley Parkway � Crystal Bay,MN 55323 Approved By: Amount$: Phone(952)249-4600 Fax(952)249-4616 y� � ;� ��KssH o��G CITY OF ORONO —MECHANICAL PERMIT (nll Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall) GENERAL INFORMATION 1. You may apply far 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 notice required) 7. House Heating Test Recard must be submitted before final. TYPE OF PERMIT (Check All That Apply) �Residential ❑ Commercial(Approval Required) �New ❑ Additional ❑ Repairs ❑ Replace Job Site / Owner Information: Site Address: �� _ �� . D� � , Owner: � Mailing Address: � City: L/'�� Zip: Home Phone: �� b��8�9� Alternate Phone: Contractor Information: 1 Contractor: ' � Contact Person: /(�/� /�/ Address: �� ` /! �✓�`�' / `� State Bond #: City: Zip?�� ` Expiration Date: Phone: ��`��l � ��/ 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 ❑ No HEATING SYSTEMS � Quantity: Make: w Y Model: Fuel: Fiue Size: Input BTUs: �O ��`-� 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/Masonry VENTILATION ❑ Na Kitchen Exhaust duct recirculating cfin ❑ No. Bath Exhaust(must have duct outside) cfm ❑ No. Other Fans: Locations cfm FUEL STORACE (Must be approved by Fire Marshall if proposing to abaridon tank in place.) ❑ Installation ❑ Removal Fuel Oil: gallons ❑ Underground ❑ Inside ❑ Outside LP Gas: gallons Other: GAS LINE ONLY ��^ � ,,`/' "' � L„ ❑ Outdoor Grill � Other/List What& Where: l/"�' � � � 2 �L�V"�" � �� , �. PERMIT FEE CALCULATION(S) BASED OFF - 2002 STATE STATUE I ❑ Yes,this section applies The replacement of a Residential fixture or appliance that meets all three of the followin�requirements: 1. Does not require modification to electrical or gas service. 2. Has a tota] cost of$500.00 or less;excludin�the cost of the fixture or appliance: and 3. ls improved, installed or replaced by the homeowner or licensed contractor. Skip next section, if this applies; Cost of Permit $ 15.00 State Surcharge $ �.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) �O x .0125 $ contract price) (minimum$50.00) 2. STATE SURCHARGE x .0005 $ (contract price) 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 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 far permit fee purposes. In the event that there is a dispuee on the amount of the job cost, the City may request the submission of a signed copy of the actua] contract. MECHANICAL PERMIT APPLICATION 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. � t �� Applicant's Signature: Date: 3 ^ ✓ �-- DATE TIME CITY OF ORONO CALLED IN � ---��- INSPECTION N TIC UO�. �HEDULED -� _�4.,�v PERMIT NO. 51�oMPLETED - ADDRESS �� ' OWNER LEP ONE NOf��1-$�� '89 9� CONTRACTOR � DESCRIPTION ��' V�-�- � � W ❑ FOOTiNG ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � Q ❑ FRAMING O MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNERIFIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOH TO MEET YOU:_Y _NO ��., COMMENTS: � W a � � O � � O � W � Q � 2 W � W � j W ❑WORK SATISFACTORY:PROCEED JECT COMPLEfE � ❑CORRECT WORK&PROCEED ❑ IS E CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 24 hou in advance. (952� 249-4600 OwnerlContractor on site: Inspector. White Copyflnspector's File Canary CopylSite Notice � / D E � TIME � CITY OF ORONO CALLED IN F�` —/ INSPECTION NOTICE �HEDULED S—/ /D:D�l' — PERMIT NO. ! �COMPLETED ADDRESS � e OWNER TEL H E N . a'l�3�'1� 'Z CONTRACTOR �S � DESCRIPTION � � D FOOTING PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL Q ❑ 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 v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNbATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � � J Or-- � � `- n O � W � Q � 2 W � W � J d � ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE w RECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WFLL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR �INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 24 hou in advance. 2) 249-4600 OwnerlContractor on site: % Inspector. White Copyllnspector's File Canary CopylSite Notice