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CITY OF ORONO PERM�T No.: 2oli-000�i
• 2750 KELLEY PARKWAY
ORONO, MN ��356- �ATE �ssuEn: 02/03/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 2425 DUNWOODY AVE
PIN : 20-117-23-22-0009
LEGAL DESC : TOWNSITE OF LANGDON PARK
: LOT 003 BLOCK 008
PERMIT TYPE : MECHANICAL(> $500)
PROPERTY TYPE : RESIDENT[AL
CONSTRUCTION TYPE : FIREPLACE- GAS
VALUATION : $ 2,400.00
NO"I'li: 2 1 II?n"I'N GLO GAS PP
APPLICANT MECHANICAL 50.00
FIRESIDE HEARTH & HOME S"TATE SURCHARGE MECH (VALUATION) 5.00
2700 FA[RVIEW AVE
ROSEVILLE, MN »I 13 MAIL-IN FEE 2.00
(651)633-2561 MISC FEE 0.00
Minnesota State License #: 20512060 TOTAL 57.00
OWNER
'eGL►�- w �—�
2425 DUNWOODY AVE
WAYZATA, MN 55391
ACREEMENT AND SWORN STATEMENT
The�cork�br e��hich this permit is issued shall be perlormed according to
the approved plans and speci�ications,applicable Cit��approvals,and the
State L3uilding Code. �I'his permit is for only the work describcd and does
not grant permission lor additional or related�vork«�hich rcquires separatc
permits. All provisions of laws and ordinances eovernina this t��pe of���ork
shall be compicd wiUi whether or not specified herein.This permit�a�ill
czpirc and bccomc null and void if construction authorized is not
commenced wilhin I 80 days of the date of issuance.or if construction is
suspcndcd for a period of 180 da}�s at am�time aftcr���ork has commcnccd.
I�he applicant is responsible fi�r assuring all required inspections are
requested in conl��rmancc with the State l3uildins Code.This permit may be
rcvokcd at any timc for duc causc.
`,�tit�"% �—r` / / CiiY/'1-�-� l l
Applicant Permitec Signaturc Date Issucd [3��.' naturc Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
� FOR C[TY USE ONLY
. O,¢��O City ofOrono
P.O.Box 66 Date Received: Permit#
2750 Kelley Parkway
.� s'''p• F Crystal Bay,MN 55323 Approved By: Amount$:
tie ' �"� -`c` Phone(952)249-4600 Fax(952)249�616
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CITY OF ORONO—MECHANICAL PERMIT
(All Commercial permits must be approved by the Building Ot�icial or Inspector and/or Fire Marshall)
GENERAL INFORMATION
1. You may apply for mechanical perrnits 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 retum 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 Designs—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,eyuipment 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 1
❑Residentia( ❑ Commercial(Approval Required)
❑ New ❑ Additional ❑ Repairs ❑ Replace
Job Site/Owner Information:
Site Address: � ��� � I��n w uza� y �✓' �C
Owner: �an (�c.(S � Mailing Address: �5��;S ��� w��7 A�'�
City: ��vn U Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: Contact Person:
E-r�r.rth&Home Technologies,Inc.
Address: State Bond#: d�a Fireside Hearth & Home
L_icense 205120
2700 N. Fairviow Ave.
City: Zip: Expiration Date: rj:tisevilie, MN 55113
Phone: Alternate Phone:
❑ Insurance—Current:
1
, MECHANICAL SYSTEMS BE1NG INSTALLED
Note: All Geothermal Systems will now require a Site Plan& Review by our Building Official.
IS THIS GEOTHERMAL? ❑ Yes �io
HEATING SYSTEMS
Quantity:
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOL[NG SYSTEMS
Quantity:
Make:
Model:
Tons:
H. Power
FIREPLACES
a ,� Gas Factory Fireplace Brand Name: �-��C�� � (��� �
❑ Wood Burning Fireplace
❑ Wood Stove Model No.: 7,j('T�Q,S
❑ Wood Stove with Flue/Masonry
VENTILATION
❑ No. Kitchen Exhaust duct recirculating cfm
❑ No. Bath E�chaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfin
FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.)
❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑ Inside ❑Outside
LP Gas: gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill ❑ Other/List What&Where:
2
PERMIT FEE CALCULATION(S)
BASED OFF - 2002 STATE STATUE
❑ Yes,this section applies
T'he replacement of a Residential fi}cture 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;excludine the cost of the fixhve or appliance:and
3. Is improved,installed or replaced by the homeowner or licensed contractor.
Skip ne�ct section,if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $ 22.00
PERMIT FEE CALCULATION S -JOBS OVER$500.00
If above does not apply;follow guidelines below:
1. CONTRACT PRICE * is l.25%of contract price with a(Minimum Fee of$50.00)
"��yrrr�. � X.o�2s $� 50_�
(contract price) (mioimum$50.00)
2. STATE SURCHARGE **Add the State Bldg Code Div. Surchatge(Minimum Fee ofS5.00)
�o'lyr.�. � X.000s $� ,S-�
(contract price) (minimum$5.00)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $� J� 7. �V
■ * 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.
■ ** The STATE SURCHARGE is.0005 times the Contract Price or a minimum of$5.00.
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.
ApplicanYs Signature: Date: � � ��
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