HomeMy WebLinkAbout2015-00348 - mechanical � CITY OF ORONO * 2 0 1 5 - 0 0 3 4 8 *
2750 KELLEY PARKWAY DATE ISSUED: 03/26/2015
ORONO, MN 55356-
952 249-4600 FAX: 952) 249-4616
ADDRESS : 20 CRYSTAL CREEK RD
P[N : 33-118-23-33-0007
LEGAL DESC : CRYSTAL CREEK
: LOT 001 BLOCK 002
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL-MULTIPLE
VALUATION : $ 4,376.00
NOTE: (1)BRYATN FURNACE
NATURAL GAS
6"FLUE
12Q000 INPUT BTU'S
115,200 OUTPUT BTU'S
925-2055 CFM
APPLICANT MECHANICAL 54.70
STATE SURCHARGE MECH(VALUATION) 2.19
DUCTWORKS HEATING AND AIR MAIL-IN FEE 2.00
6108 OLSON MEMORIAL HWY
GOLDEN VALLEY, MN 55422- TOTAL 58.89
(763)521-0070 Payment(s)
Minnesota State License#: mech-MB003589 CREDIT CARD 6613 58.89
OWNER
GAGNE& STACEY WILSON, STEVE
20 CRYSTAL CREEK RD
LONG LAKE,MN 55356
AGREEMENT AND SWORN STATEMENT
The work Yor which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
S[a[e Building Code. This permit is for only[he work described and does
not gran[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[ime after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the S[ate Building Code.This permit may be
revoked at any time for due cause.
� � � � 2�i/�
Applicant Permitee Signature Date Issu By Signature Date
. t
F R CIT U ONLY r D �, �� /7
� O � City of Orono a � �LI-J
� /� N P.O.Box 66 Date Recei �Perm�t#�� `� � �
0 �. 2750 Kelley Parkway
�
� Crystal Bay,MN 55323 Approved By_ Amount$:
� ' , , ^ � Phone(952)249-4600 Faac(952)249-4616 ��
' � i , l .�%', /� �
� � `' ' CITY OF ORONO—MECHANICAL PERMIT
� y
��'�fSH����� �
�-�_ __ (All Commercial permits must be approved by the Building Official or[nspector and/or Fire Marshall)
GENERAL INFORMAT[ON
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 A I )
�Residential ❑Commercial(Approval Required)
❑ New ❑ Additional ❑ Repairs �Replace
Job Site/Owner Information:
Site Address: v�U ���151�lL ��� �8�� �.x11K� ✓`�5,j.`�-6
Owner: ST�Et�/ff_n% �h�lE MailingAddress: �U C,eyS�AL �REE,C 2�
T
c�ri: Lb,�� ��r.� z�p: ss.js.�
Home Phone:��/.�� ao E -��;;2� Alternate Phone:
Contractor Information:
Contractor: �;��7w��►cs �Eayi,ilc, Contact Person: D�����1n cc Sc�j'�
Address: ;b I�5� r)1..5��1/1�em��aZ I-�wy State Bond #: 111�1 B t�c,35 R`1
Clty: k�o�OfN A�LE Z1p:5sy,��. Expiration Date: `��/6Ia�'l.�
Phone: ��3'-5,��- 0�7� AlternatePhone: �l� - 7�9-`il/l �.Sc��7�'�
� Insurance—Current: C�nJe1,u;,�Ari Ini>. �o .
1
MECHAN[CAL 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: 1
Make:
Model: �;�5'Tf� �(/,�101�,��
Fuel: n/�}T �H$
Flue Size:
6 ��
[nput BTUs: /;�D L�C>p
Output BTUs: �$ �v z�
CFM: � C
�_�__`'�°_ `�
COOLING SYSTEMS
Quantity: _
M ake:
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 Exhaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfm
FUEL STORAGE (Must be approved by Fire Marshall ijproposing to abandon tank in p/ace.)
❑ Installation ❑ Removal
Fuel Oil: gailons ❑ Underground ❑ Inside ❑Outside
LP Gas: gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill ❑ Other/List What& Where:
2
PERMIT FEE CALCULAT(ON(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;excludin�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)
73�y . t�« X .0125 $ 6s �y
(contract price) (minimum$50.00)
2. STATE SURCHARGE
S1,3`16. v c; X .000s $ �• � 9
(contract price)
3. POSTAGE& HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ b 1• 0 3
■ * 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 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: ,3�.��/�/.S
3
�i6nnesot8 Departm�t of t�bor and Ir�ry Licensing and CertifEcation Servioes
Cor�struction Codes and lrcensing Dlvisian Phor�e: 651.284.503�t
443 L.afayette Road N Ema�7: D����•+�••••s
Saint Paul,MN 5515� Website: waMr-�'inin-9arhx�d�p
NOTICES
NOT TRANSFERAB�E DUCTWORKS HEATING&AIR CONDITIONING LLC
CHANGE Y�UR BUSINESS STRUCTLiRE s�08 OLSON MEMORtAL HwY
SUBlMT A NEW APPtICAT10N FOR NEW ENTRY R�B��SDALE,MN 55422
RENEW IN3 REPL.ACE INSURAAICE POIJCY
SUB�IIiT NEW CER7iFlCATE OF INSURANICE
NOTIFY THE DEPARTAAEWT OF A CHANGE IN YOUR BUStNESS.
Failure to do so,subjects you to administrative pernalties of up to$70,400.
15-Day Notice Requiremerrt-Forms available ontine_at=www.dli.mn.qov/CCLD/LicUpd�ate.esp - - _ -_ _
• Change in business'physical=address,mai(ing:address,phone number,or email address = _ =
• Change in corrtrol,=owners;officers,diredors,members,Aartners _- __ _ � - --
• Change in business'lega[name and/or assumed name
. Loss of or change in RESPONSIBLE INDIVIOIlAL
. Change in generat('iabifity insurance or workers'compensation insurance coverage
i�nmediate NoUce Requiremerrt—Notification to DU in writing
. JudamenF Debtar_ A lioensed oontractor has 15 days to provide written notice of the finding that_it-is_found to be a jc�dc,pr�st
debtor based upon cond�d requiring licensure. --` -
• Banlat�ptcy Petition Filed.:A licensed contractor has:15 days to provide written noGc�#hat it fil�a petitiortfor ban(�t_
• Convic6on Notic� A licensed oontrador has 10 days 3o provide written notice that it has been fowid guilty of a fetorry,gross
misdemeanor, misdemeanor or any comparable offense relabed to the license, indudmg convicbons of �d,
misr�presentation,misuse of iunds,theft,criminal sexual conduct,assau�,burglary,conversion of funds,or the�af proceeds
in this or a►ry other sta#e or any other United Statss juri�idion_
YOUR CERTIF�ATE�BELOW THE PERFORATION. SHOW CERTIFlCATE WHE�f OBTAIN�PERf�iS.
� :` '�'�A�M�,-� = II�ECHANICAL CONTRACTOR BOND
LABOR&Ih1Dl1STRY
a:
Cons�uc6on Codes atM Li�s'sg D"nrision Li�nsing and C�n Services 443 La�yel6e Road N SL Pa+f,MB�I 56i55
1Atehs�e: ve�wv.�.nn:qw/a9d.asa� Eme� �st�afu►.us Pf�a�&51284.56.i4
This is to ce�tify that thc cetificabe holder is registe�i as a MECHANICAL CONTRACTOR BOND in the staoe of Mmneswa a�is in oo�grt�snce
with Minnesota StaWtac 326B.197,and has fiied a$25,�0 mechanical boad to perform gas,h�ventilatioa,cooling,air conditionin�
fiiei bu�ning,o�refrige:ation�varlc m all areas of the shate during the regis�ation period;Provided the work pErfo�ed complies with-,_ _
the State Mochaaicat Gode and ttte certifcatel�lder mamtaros compli�e wit�8te r�qimed bott�aIId wock�s'com�ott 1aw� - _
Reg'�stra�n : 1�ECHANICAL CONTRACTOR BOND � �
RegNumber : M800358s DUCTWORKS HEATING&AIR CONDITIONlNG LLC �
Eifectiv�D9t� _ '1 O/O'!/2D'14 6�OS OLSON MEMORIAL HWY 8
Expaa�ion Date : o9/1s�2o16 ROBBINSD�►1.E,MN 55422 �
T
VERIF1/URTO-DATE STATUS;BOND;AND=INSURANCE MlFO AT rwvw.dli.mn.govlacfdRicVerl�.asa(ENTER P1UYB�.
�$S ��� CERTIFICATE OF COMPSTffidCY
' ' This Certificate must be r�neaied Aaaually aad is NOT transferrable
; City Of Mi.aaeapolis �� ~612-693-5892
; Inspectioas Division
; 250 So. 4th St. �ipls, E�T 55415 2��.5
�
� CLRTIFICATL OF COMP$T�iCY
;xeep thia card ia your poeaeasiom an the job.
MAIL TO: ��$ is to certify that: SC01R SOI�IDRALL
; holds the following competeacies:
SCOTT 50NIDRALL � �
53ZQ TRITON DEIVB : �787 �+� as8ctxc�sRATi� �sTALLaR
�
GOLDSN 1TALr.rv� ffiN 55422 � Slfl�I534 xncmraw y� gig ma�m�rar_ nQSTALLBR
i GFM171058 MASTSR GASFIITSR
�
i
i
t
�
�
�
i
�
�
Inspections Division �
250 So. 4th St Mpls MN 55415 ;TggS$ CO�E3�iCI$S ESPIRS: Nov. O1, 20I5
,4co� CERTIFICATE OF LIABILITY INSURANCE °"'�`""°°"'""'
�..�- ii�2i�2oi4
THIS CER7IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RlGHTS UPON THE CERTIFICATE H�DER TFNS
CERTIFlCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POtJC1ES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: ff the certficate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed if SUBROGATION IS WAtVED,subject to
the terms and condfions of the policy,certain policies may require an endorsement A statement on this certificate does not co�er rigMs to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT J8n Herz
NAME: �
�OI.1.0 Insurance �eI1CI7 PHONE _ (320)256-7401 F� �:(855)927-6655
5 Fifth Avenue SE E-�'�� anh@a lloinsurance.com
ADDRESS:� P�
INSURE S AFFORDING COVERAGE NAIC S
l�elrose 1yIl�T 56352 iNsur�R a Gincinnati Insurance Com 0677
INSURED INSURER B•
DHC Incorporated� INSURER C:
DBA Ductworks Heating and Cooling INSURERD:
6108 Olson Memorial Hwy INSURERE:
Golden Valley A4i 55422 INSURERF:
COVERAGES CERTIFICATE NUMBER2o14-15 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 TERM.S,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
��� IYPE OF INSURANCE �� B pOLICY NUMBER M�UCY EFF M�Y EXP U�S
GENERAL LiABIL1TY
EACH OCCURRENCE S 1�OOO,OOO
X COMMERCIAL GENERAL LU181LITY A GE T
PREMISES Ea ocarrence t lOO,OOO
A CIAIMS-MADE �X occuR cro29o�00 1/14/2014 i/ia/2ois �D IXP(Arry one person) a 10,000
P�tSonwL&anV IruURY S 1,OOO,OOO
G�EanLAc,�REc�,� s Z,OOO,OOO
GEN'L AGGREGATE L�Mff APPLIES PER: PRODUCTS-COMP/0P AGG S 2�OOO�OOO
X POLICY �a LOC =
AUTOMO&LE W461LITl' COMB�INdE�D SINGLE IJMff 1 dOO OOO
A X ANYAUTO BODILYIWURY(Perperson) S
ALLOWNED SCHEDU�ED CP0290700 1/14/2014 1/14/2015 gpDILYINJURY(Peraaitlent) $
AUTOS AUTOS
HIRED AUTOS NON-0NRJED pRppEitTy pqµqGE s
AUTOS Per ac6derd
UrMerinsured moforist s
X UMBRELLA W16 pCCUR EACH OCCURRENCE S 2�OOO�OOO
A �CE��B CLAIMS-MADE AGGREGATE S 2,OOO,OOO
DED X RETENTIONE CP0290700 1/14/2014 1/14/2015 =
A WORKERS COMPENSATION X WC STATU- OTH-
AND EMPLOYERS LIABILITY Y f N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT S 5OO OOO
OFFlCER/AAEMBER EXCLUDED? � N�A
(Mandatory in NH) 150878 1/14/2014 1/14/2015 E.L DISEASE-EA EMPLOYE E 500 000
if yes,desaibe under
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMfT j SOO OOO
DESCPoPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 707,Additional Remarks Scheduie,if more space is requlred)
CERTIFICATE HOLDER CANCELLATiON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLFD BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEL.IVERED �1
CiL'y of Oreno A��DANCE WITH THE POLICY PROVISIONS.
2750 Kelley Pkwy
Orono, l�i 55356-9387 AUTHOR�DREPRESENTATIVE
Paul Olberding/APOJAH �� O
ACORD 25(2010/05) O 1988-2010 ACORD CORPORATION. All rigMs resened.
INS025l7(NfY�1I1� Thn A�_ARII n�mn�nri Innn�ro ronicMro�l m�rlrc nf A(_ARfI