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# PERMIT
CI�TY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 _ _ _ _ '
Permit Number: =�-��"
Crystal Bay, Minnesota 55323 - ' - -- �
(612) 249-4600 Date Issued: -
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: - -. - _ . . �_ -- OWNER:
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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CITY OF ORONO �� � APPLICATION FOR MECHANICAL PERNIIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, NIN 55323
GENERAL INFORMATION
1. You may apply for mechanical permits by mail or in person at the City offices. Applications will be
reviewed and a pernut will be issued within 2 working days.
2. Permit cazds 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 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.
Datr. s'�a:l be pres:,:.ted o..fc;-cr.Frovid�d. Ident:`cat;:,..a.an�spec:fcat:cns for water heating equipment
shall also be provided.
4. When any new construction or remodeling is involved, a separate building pernut must be obtained.
5. Ail work must be done in accoraance with the Uniform ivlechanicai Codei�tate Building Cocie
requirements.
6. All work must be inspected (rough-in and final). Call 249-4600. 24-hour notice required.
7. House Heating Test Record must be submitted before final.
Instructions Complete all items on this application. Compute the permit fee. Sign and date the certification.
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call 249-4600.
Please check one: New Addition Repair ,/,, Replace
✓ Residential Commercial
JOB SITE: "3 _"" '' �' � Zip:
Owner's Name: '�, r , �.�� Telephone Number: �� i i -'!<;�(�c,
Mailing Address: ity: Zip:
Contractor's Name: ,,,,��eQ� Telephone Number:
Mailing Address: �
�114N RAPICLS MN 55433 City: Zip:
!�.";12)757-5040
SYSTEM DESCRIPTION
HEATING SYSTEMS
Quantity: �
Make: t�u�t�1
Model: ;�c�n�l
FueL• �'�",� (�'�'' �
Flue Size: � "
«
Input BTUs: 1'=��� �.;�'
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H. Power
, '
;
WOOD BURNING EQUIPMENT
Wood stove with flue
Wood combination or add-on
Factory fireplace with flue
Factory Fireplace (s) Freestanding Masonry
Wood Stove (s) Franklin, other
Brand Name Model No.
Mfgr's Min., Clearances, side , rear , min. flue dia.
VENTILATION
No. Kitchen Exhaust ducted recirculating cfm
No. Bath Exhaust (must be ducted outside) cfm
No. Other Fans: Locations cfm
FUEL STORAGE (MUST BE APPROVED BY FIRE Mt�RSHAL)
Installation Removal
Fuel oil: gallons underground inside outside
LP Gas: gallons
Other Gas opening
PERMIT FEE CALCULATION
1. 1.25% of Contract Price* or Minimum Fee ($35.00)
;�,;�,�,,�_��; x .oi2s � 3�.����,
(contract price)
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit. �'�-�t���;.C'�-: x .0005 $ �7L�
or $.50, whichever is greater (contract price)
3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3 � .;;Z��`
* CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pemutted
work includir,g materials, labar, grofit, and other fi�ed cests. It is the amount to be charged to the
customer for the work done. If any material, equipment, labor, or installation 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.
** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
greater. For valuations over $1,000,000 call tlie Depart�nent of Inspectional Services for the price.
The undersigned hereby applies e for issuance of a Mechanical Per�'t, agrees to do
all work in strict accordance rth the dinances of the City� and the regulati�is of the Minnesota
State Building Code, and ertifies at all statements made bn this applica�i�on are;complete, true
and correct. ' � `
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A licant's i na '�-�,�---��'-� Date: �j r
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Approved By: Date: l � � � �l
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