HomeMy WebLinkAbout2011-01090 - gas line only � CITY OF ORONO PERMIT NO.: 2011-01090
2750 KELLEY PARKWAY
' ORONO, MN 55356- DATE ISSUED: 09/20/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 930 COX FARM RD
PIN : 27-118-23-33-0013
LEGAL DESC : SHADOWOOD FARM
: LOT O10 BLOCK 001
PERMIT TYPE : MECHANICAL(> $500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : GAS L[NE ONLY
VALUATION : $ 800.00
NO"I'L: GAS LINES TO(2)SEPARATE FIREPLACF.S
APPLICANT
MECHAN[CAL 50.00
NRH PLUMBING INC.
6460 153RD LN STATE SURCHARGE MECH(VALUATION) 0.40
RAMSEY, MN 55303- TOTAL 50.40
(612)245-7280
Minnesota State License#: 067436 PM
OWNER
KILLINGSTAD, MR.& MRS.
930 COX FARM RD
LONG LAKE, MN 55356
AGREEMENT AND SWORN STATEMENT
Thc work for which this permit is issued shall bc performcd according to
the approved plans and specifications,applicable City approvals,and the
State[3uilding Code. This permit is tor only the work described and does
not grant permission for additional or related work which requires separate
pennits. All provisions of laws and ordinances governing this type of work
shali be compied wilh whether or not specified herein.This permit will
expire and become null and void if construetion authorized is not
commenced wi[hin 180 days of the date of issuance,or if construction is
suspended for a period of l80 days a[any[ime atter work has commenced.
The applicant is responsible for assuring all required inspections are
requested in nfonnance ith[ State[3uilding Code.This permit may be
revoked at an time for d ca s �
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Applicant Permitee Si a re Date Issue 13y nature ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER HAN DESCRIBED AB .
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� , FOR CITY USE O1VLY —�
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City of Orono
P.O.Box 66 Date Received: Yermit#
, ��,,, � i 2750 Kelley Parkway I
� �y'�'71;r'' � Crystal Bay,MN 55323 Approved By: Amount$:
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�,��y�o�t~ Phone(952)249-4600 Fax(952)249-4616
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CITY OF ORONO —MECHANICAL PERMIT
(All Commercial permits must be approvcd by the Building Official or Inspector and/or f�ire Marshall)
GENERAL 1NFORMATION
1. You may apply for mechanical pernuts by mail or in person at the City offices. Applications will
be reviewed and a pernut 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 Desi�ns—Complete calculations, details and specifications are required for each
hearing, ventilation,humidification-dehumidification, and air conditioning installarion 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 pernut 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 ply)
❑Residential ❑ Commercial(Approval Required)
❑ New ❑ Additional ❑ Repairs ❑Replace
Job Site/Owner Information:
Site Address: 9 3 G ��x -�aq-�2 v� C�-A
Owner: M�- ���`-�-5`^'�S•-F►�+D Mailing Address: S��^-�-e-
City: ���'�^ o Zip:
Home Phone: " Alternate Phone: �e 2 3(�C.s .�� 7 7
Contractor Information:
Contractor: l�R� P��w���y +��. Contact Person: �`J'� }-�v�f-�
Address: �`-��� ��3�� �N State Bond #: `f�bi ' ���
City: ���-� Zip: w,�✓ Expiration Date: 3�3�� Z
Phone: lo�? 2 y 5" ��Z�7 Alternate Phone: `�
❑ Insurance—Current: y.P/�
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'.n. MECHANICAL SYSTEMS BEI137G 1NSTAT�LED �K, � � � . �
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/Masonry
VENTILATION
❑ No. Kitchen Exhaust duct recirculating cfin
❑ No. Bath Exhaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfm
FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandofa tank in p[ace.)
❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑ Inside ❑ Outside
LP Gas: gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill [.� Other/List What&Where:�� ) S t�-���� �i�,���a t t s ,
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PERMIT FEE CALCULATI4N(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; excluding 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 CALCULAT��ON � .= C��.S';�: VER$500�0� �` ` '� �� �
If above does not apply; follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
cjr(� � x .0125 $
(contract price) (minimum$50.00)
2. STATE SURCHARGE �
�CJ7i 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 actuai 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
esrimated 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 far 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: Date: � � Z�� �1
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