HomeMy WebLinkAbout2012-01107 - mechanical } a �
CITY OF ORONO * z 0 1 z - 0 1 1 0 7 *
2750 KELLEY PARKWAY DATE �SSUED: 10/31/2012
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2745 ETHEL AVE
PIN : 20-117-23-24-0016
LEGAL DESC : CASCO HEIGHTS
: LOT 000 BLOCK 003
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE ; RES[DENTIAL
CONSTRUCTION TYPE : MECHANICAL- MULTIPLE
VALUATION : $ 1,379.00
NOTF:: (l)LENNOX HEATING SYSTEM-ML180UH070Y24A03-Gi1S-5" FLUE
70,000 INPUT BTU'S,56,000 OUTPUT I3TU'S,800 CFM
APPLICANT MECHANICAL 50.00
STAFFORD HOME SERVICE INC. STATE SURCHARGE MECH (VALUATION) 0.69
6225 CAMBRIDGE STREET
ST LOUIS PARK, MN 55416- MAIL-IN FEE 2.00
(952)927-7194 TOTAL 52.69
OWNER
PEIFER, AMBER
2745 ETHEL AVE
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
"I�hc work for which this permit is issued shall be performed according to
the approved plans and specitications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permissia�for additional or related work which requires separate
pennits. All provisions of laws and ordinances governing this type of work
shall be compied wi[h 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 time after work has commenced.
1'he applicant is responsible for assuring aIl required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cau .
� /D i�-l i l �-� -!/( /(� lv�� i l��
Applicant Permitee " re Date Issuc y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
, , . w
FOr�CIT USE ONLY
'�� �� City of Orono �Q/ y� ��
¢ � � P.O.Box 66 Date Received:6 rmit#�!J��—� �
ti
�,2 ��'� 2750 Kelley Parkway
� �t�p �.' Crystal Bay,MN 55323 Approved By: Amou�t$: �i �
�.�
� ''�� � ,��a`,�% Phone(952)249-4600 Fax(952)249-46I 6
'�4�sxoe,-
CITY OF ORONO-MECHANICAL PERMIT
(All Commercial permrts 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'�IOT
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. 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 �eplace
Job Site/Owner Information:
Site Address: � �� ��� ���--�L 1.1 � �-�
Owner: `�'�!�)L✓� �C J-��� Mailing Address: ���� ��� L /I v�
City: __�l���/lJ� Zip: � �� 1
���� _ �
Home Phone: �Q����t� Alternate Phone:
Contractor Information:
JT��U�D C-t"Urn�
Contractor: Contact Person: ��."����
� - � �
Address: ���i�n,� �„ ry„���� State Bond#: �� ����c�-�
` l� .--�-
City: �'j��� Zip:�����° Expiration Date: � � � � �
Phone: C 5 �''(���1 � � ��� Alternate Phone:
� l
❑ Insurance-Current: ��
]
. . -•
MECHANICAL SYSTEMS BEING INSTALLED
Note: All Geothermal Systems will now requi e a Site Plan & Review by our Building Official.
IS THIS GEOTHERMAL? ❑ Yes No
HEATING SYSTEMS
Quantity:
Make: -� � Q/�
Model: m � l$D � /IU� � Y<2�l'�"U �
Fuel:
�i�
Flue Size:
Input BTIJs: � ���/
�Ucpuc sTu,: �7 Q�D
CFM: ��D
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 _ cfm
❑ No. Bath Exhaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfm
FUEL STORAGE (Must he approved by Fire Marshall if proposing to abandon tank in pluce.)
❑ 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
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. ]s 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 CAL�ULATION(S)-JOBS OVER$500.00
If above does not apply;follow guidelines below:
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00�
�} � �, 3
�� � ! �� x.0 I 25 $ �j� � ��
(contract price) (m i n i m u m$50.00)
2. STATE SURCHARGE v2�%� �� /_C�
��� x.0005 $ r (-�� I
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
(�/ 7 -
�! ✓
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �
■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged far 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. ln 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 accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies th all statements made on this application are complete, true and
correct. �
pP g � U �� ��
A licant's Si nature: � Date:
�
Reset Form � ��r1.Q 'U�'CQ�
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�� DATE TIME �/
CITY OF ORONO CALLED IN !a-a�
INSPECTION NOTICE SCHEDULED �a�27-/o� � .��
PERMIT NO.�Df�—���D � COMPLETED
ADDRESS a 7 � �-� � C��� �/_
OWNER ���� EL PHONE NO l��Z 7D Z 7Y'ZD
CONTRACTOR
�: DESCRIPTION
�
t1� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
� ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
�
O ❑ 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. ❑ FOLLOW-UP
_ � DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
� ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
�
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GW ❑WORK SATISFACTORY:PROGEED �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
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. �95Z� Z49-46�0
OwnerlContractor on site:
Inspector, l 1 ! �
White Copy/lnspector's File Canary Copy/Site Notice