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Home My WebLink About2013-01025 - gas line only ' CITY OF ORONO * z013 - 01PJ25 * 2750 KELLEY PARKWAY DATE ISSUED: 10/O1/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2695 COUNTRYSIDE DR W PIN : 04-117-23-13-0005 LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN : LOT 005 BLOCK 003 PERMIT TYPE : MECHANICAL(> $500) PROPERTY TYPE : RESIDENTIAL CONSTRUCT[ON TYPE : GAS LINE ONLY VALUATION : $ I,550.00 NOTI�:: GnSLINE 1'OR POOL]IGn"I'I;R-2�0.000 F3TU APPLICANT MECHANICAL 50.00 METRO GAS INSTALLERS STATE SURCHARGE MECH(VALUATION) 0.78 685 141ST LANE NW ANDOVER, MN 55304 TOTAL 50.78 (763)754-71 19 OWNER BICKETT, SCOTT& HOLLY 2695 COUNTRYSIDE DR W LONG LAKE, MN 55356- AGREEMENT AND SWORN STATEMENT 7�he work for which this permit is issued shall bc performed accordin�to the approved plans and specitications,applicable City approvals,and the State[3uilding Code. �Chis 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 N�ork 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 it�construction is suspended for a period of l80 days a[any time aYter work has commenced. �he applican[is responsible f assuring all requi nspections are requested in confor ce h th t te B 'Id' ode."Chis permit may be revoked at any.. or e ca e. � � �� ,- � / A cant Permitee Si=nature Date �� pp � Iss By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. .`� "^� FOR CITY USE ONLY �O�O City of Orono ,�j �7� -7� P.O.Box 66 Date Receivefl� / Permit#aEJl3 b� db-� 2750 Kelley Parkway Crystal Bay,MN 55323 Approved By: Amount$:�•� Phone(952)249-4600 Fax(952)249-4616 � ,. 1 y � F � ��' CITY OF ORONO -MECHANICAL PERMIT ��KES H O� (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 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 Record must be submitted before final. TYPE OF PERMIT (Check All That Apply) � Residential ❑ Commercial(Approval Required) ❑ New ❑ Additional ❑ Repairs �Replace Job Site/ Owner Information: c Site Address: �� ''� � �� Q . ' , �`� � � ,�Q l� �� Owner: �� U�� Mailing Address. �y J � City: j 1�� Zip: Home Phone: Alternate Phone: ��1��O� `� � 3=� Contractor Information: / a�� o � � P rson: �� Contractor: / � �lS Contact e � Zo � �/ <f-- ,/ ) Address: �� 7� �� v �"� State Bond#: , �C3�� City: ��'�� Zip:J Expiration Date: Phone: ��'�-�� / �� Alternate Phone: � �� ❑ Insurance-Current: 1 ��, -., MEC�IANICAL SYSTEMS BEING INSTALLED Note: All Geothermal Syste�ns will now require a Site Plan & Review by our Building Official. IS THIS GEOTHERMAL? ❑ Yes �No HEATING SYSTEMS Quantity: Make: Model: Fuel: Flue Size: lnput BTUs: Output BTUs: CFM: COOLING SYSTEMS Quantiry: Make: ModeL• Tons: H. Power FIREPLACES ❑ Gas Factory Fireplace Brand Name: ❑ Wood Burning Fireplace ❑ Wood Stove Model No.: ❑ Wood Stove with Flue/Masonry VENTILATION ❑ No. Kitchen Exhaust duct recirculating cfm ❑ No. Bath E�aust(must have duct outside) cfm ❑ No. Other Fans: Locations cfm FUEL STORAGE (Must be approved by Fire Marshal!if proposing to abandon tank in p/ace.) ❑ Installation ❑ Removal Fuel Oil: gallons ❑ Underground ❑ Inside ❑ Outside LP Gas: gallons Other: GAS LINE ONLY ^n� , � � «� ❑ Outdoor Grill Other/List What&Where: � � � I � 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. Is improved, installed or replaced by the homeowner or licensed contractor. Skip next section, 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 125%of contract price with a(Minimum Fee of$50.00) �� x .0125 $ (Z"ontract 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 far 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. MECHANICAL PERMIT APPLICATION AGREEMENT The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all work in strict accardance 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. �!G" � �_' � J � Applicant's Signature: � � Date� 3 �-�+ DATE TIME � CITY OF ORONO CALLED IN ��— �—�3 INSPECTION NOTICE SCHEDULED LO-a- /3 q-�d� PERMIT NO. ��3 -�ld�S cornP�ErEo ADDRESS a�0�5 �Q �� OWNER TELEP ONE N .��- �3y-3�i� CONTRACTOR � ��' �/�-�-r�— �: DESCRIPTION r v�� '�` ` � t~L� ❑ FOOTING ❑ PLUMBING FINAL v V '— V/GR ING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE O 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 � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � J '� l O O , � ��.__.. � V Y � O � W � Q � Z W � W � � GW�LSAilSFACTORY:PROCEED f7 PROJECT COMPLETE � ❑CORRECT WORK&PROCEED ^ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. �; pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED C INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� Z49-4600 OwnerlContractor on site: Inspector. White Copyllnspector's File Canary CopylSite Notice DATE TIME � CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED �� PERMIT NO.a0/�3 - 6/d°Z5— COMPLETED ��-/�o�l� � ADDRESS v�6 fu` ��s.Y-�'K. Si.O� �• !�/ • OWNER TELEPHONE NO. CONTRACTOR �� DESCRIPTION ��s ��` � ly ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVEfLANDS h Q ❑ 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. �LLOW-UP i ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTHACTOR TO MEET YOU:_YES_NO c��, COMMENTS: a� y �/� �' / �C�/'�LN✓L /�6l,!'✓!i T��/Rt0 � C/�i� �'a'�' Q O �r i r14� �i ��fD� � � � �/(�GaJO/ �,/�i �(i � � � ° - 5 -a f� ro 0 W ! � �� Q � 2 W � � W � � � ❑WORKSATISFACTORY:PROCEED ROJECTCOMPLEfE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORFECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR Wlll RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-46�0 OwnedContractor on site: Inspector.�� White Copyllnspector's File Canary CopylSite Notice