HomeMy WebLinkAbout2014-00751 - mechanical � �' CITY OF ORONO
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2750 KELLEY PARKWAY pATE �SSUED: 07/16/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
AUDRESS : 1535 FAIRVIEW COTTAGE LA
PIN : 07-117-23-43-0007
LEGAL DESC : ORCHARD BEACFi
: LOT 003 BLOCK 000
PERMIT TYPE : MECHANICAL(> $500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL- MULTIPLE
VALUATION : $ 76,000.00
NOTE: GEOTIIERMAI.
(1)BRYANT FURNACh:
(2)BOSCN COOL[NG SYSTP,MS
(1)KI"I'CHEN EXtIAUS"1'
(9)BATH GXHAUS"1'
(1)MAKF-UP AlR
APPLICANT MECHAN[CAL 950.00
STATE SURCHARGE MECH (VALUATION) 38.00
METRO AIR INC. TOTAL 988.00
16980 WELCOME AVE SE Payment(s)
PRIOR LAKE, MN 55372
(952)447-8124 CNECK 20445 988.00
OWNER
HOUCK, DANIEL&JANE
1705 ELDORADO CIR
SUPERIOR, CO 80027-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be perYormed according to
the approved plans and specifications,applicable City approvals,and thc
State Building Code. This permit is for only the work described and docs
not grant permission for additional or relatcd work which requires separate
permits. nll provisions of laws and ordinances governing this type of work
shall be compied with whether or not specilicd herein.'l�his permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the datc of issuTnce,or if construction is
suspended for a period of 180 days at any time after work has commenced.
"�he applicant is responsible for assuring all rcquired inspcctions are
requested in conformance with the State[3uilding Code.This permit may be
revoked at an��time for duc cause.
�t►..��,;, t�.�. 7- 1�-- I�( '7 � �lv� /�
Applicant Permitee Signature Date Issue y Signature Date
. K
FOR CITY USE ONLY
�,t� City of Orono
O¢O`rO\� P.O.Box 66 Date Received: Permit#
y;. ��) 2750 Kelley Parkway ��
�, g�'�!• �j Crystal Bay,MN 55323 Approved By .c 1� , Amount$:
"���,rj�•,Y�o`;��' Phone(952)249-4600 Pax(952)249-4616
�os..
CITY OF ORONO-MECHANICAL PERMIT
(All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall)
GENERAL INFORMATION
L 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
V.ALID 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 1 )
�Residential ❑Commercial(Approval Required)
�,New ❑ Additional ❑ Repairs ❑ Replace
Job Site/Owner Information:
� �
Site Address: � =�` � �� �j-�a" ,.. ,� , ��;.� �� f;;� �K. �'� �
r►C
��� '(Y�\��> r►,�.<u ,�s�i��lf`�'�V��" �><� �� i�c `j �,)
Owner: ° Mailing Address:
c;ty: � c;� �� ''�«Z �Y1� z�p: S � �5,� �
Home Phone: v'1� ' `� -� \�"-�-, -��-' Alternate Phone: `\ � . �" �� ,� �� � I
Contractor Information:
Contractor:���.-�� ��1�� s" �` r+` Contact Person: �� ��``�`-` � ��G�� �'
�
Address: ��-'�1 c�L� � �` ��5� ,,�k� State Bond#: �� `I � 1''`t �' -�
City: �, `,'\:'�'`--�`�� Zip: �� S�� Expiration Date: �� � � (�
Phone: � \ � -�- �`1���1 �h1��� Alternate Phone: �5:��� ���'. \�� �'��' �
❑ Insurance-Current:
1
MECHANICAL 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: �
Make: �'��}�h��
Model: �;?�� r��1��1�a�,�a�
Fuel: `ti�'"`�
-� ;r
Flue Size:
Input BTUs: �� ``�- ����1
Output BTUs: r 1 `-'�j���
�
CFM: ` = -� �—`
COOL[NG SYSTEMS
Quantity: ` �
Make: � L.l�L�1 '1 � J Lyl
(� - IC _5�, ����-' C: � S - 1 (j SL
Modei: �„ �
�� 1 r
Tons: ��. �" � .� � C)� , +'' <� �'=�• ,�� � 1 Gti t�-. t'<< YV � ��r
—�
H. Power
FIREPLACES
❑ Gas Factory Fireplace Brand Name:
❑ Wood Burning Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Masonry
VENTILATIOIY
No. ___�__ Kitchen Exhaust duct recirculating cfm
� No. _� Bath Exhaust(must have duct outside) , �S�c7 cfm
Q No. �_ Other Fans: Locations � ia��3�tic�� �� ; ^ cfm
FUEL STORAGE (Must be approved by Fire Marskal!if proposing to abandon tank in place.)
❑ lnstallation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑ Inside ❑ Outside
LP Gas: gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill ❑ Other/List What& Where:
2
♦ J
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;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 CALCULATION S)-JOBS OVER $500.00
If above does not apply;follow guidelines below:
1. CONTRACT PRICE * is 1.25%of contrac�price with a(Minimum Fee of$50.00)
•�J �� I ( �
� �:_ `����'��� � x .oi25 $ 1� ��
(contract price) (minimum$SOA(I)
_�
2. STATE SURCHARGE '� 1 ��� ; � --�
' C 1`�`� x.0005 $
(contract price)
3. POSTAGE& HANDLING(Only on Mail-In Applications) $ 2.00
�� � � ��
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ J
■ * 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 PERMfT 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.
' i nature�� � /� Date:� � ���� � � I ��
Appl�cant s S g
Reset Form
3
From:Sue Fischer-LeBeau FaxID: Page 2 of 3 Date:7/15/2014 12:14 PM Page:2 of 3
'`~�1 METR019 OP ID: SF
'`��-'z�' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY}
07/15/14
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERl1FICATE HOLDER.�
IMPORTANT: If the certificate holder is an ADDITIONA� INSURED, he policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and condltions of the policy, certaln policles may requlre an endorsement. A statement on this certlflcate does not confer rights to lhe
certiflcate holder in lieu of such endorsement(s).
PRoourER Phone: 952-996-8818 CON ACT
Northern Capltal Commerclal NAME:
�PHONE.._ .._ -- -..__ _._ ---
Ak_— —. __ — —
Norlhem Capital Ins Gp dba FaX: 952-829-0482 LAic No,Exg _ _ _ A��N� _
P.O. Box 939G e-Mni� — —
Minneapolis,MN 55440-9396 ADDRESS:
-- — ----— — -------
— ---- __.
Koester Insurance Services, Ifl _ INSURER(S)AFFORDING COVERAGE NAIC/
—_-- ---- --- --
—_—
' INSURERA ACUITY Insurance 14184
.. _.. --- _ ------. __._.— — --.— ___.—.. ...—.__. .--_.. .__ . . —__ .._.—_. —._._
---- ------ - �------
irisuREo Metro Air, Inc. iNsuReRe.
16980 Welcome Ave.SE — -- ----
Prior Lake, MN 55372 irisuRERc
INSURER D:
—----
INSURER E:
----�---- ----. . _.. ---�------ - --� ---
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CFRTIFY 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 TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
-- --_--- —— - — __—
_ . — —-- ---
0 �6LI�PE �bLfZ`�'EX� ------- - --- — --——
LTR Tl'PE OF�NSURANCE INSR WVD POLICY NUMBER MMIDDlYYYY MMIDD/YVYY LIMITS
GENERAL LIABILITY
-- Encr�occuRREr�cE � 1,000,000
A X �_oMnn��lan�c�NFHn�unsiurv X77996 09/01/13 09/01/14 ��0��
�- PREMISES(Ea occurrenceZ_ $ 25�,00�
�CL�IMS MADE X�OCCUP, MED E<P(Any one person) $ 'IO.00O.
--- -
- --�--- PERSON�L&ADV INJURY $ 'I,OOO,OOO
-�-------..._
- � � -�-�- ---- --�-- GENERAL AGGREGATE $ 3,000,000
GI�.P�fL AGCRFGATE LIMIT APPLIES PFR PRODUCTS-COMP/OP AGG $ 3,000�000
X F`OLICY PR 7 LOC $ � -
AUfOMOBILE LIABILITY
COMBINED SINGLE LIMIT
fEaaccidenq_ _ _ g 1,000,000
A nNv nuro X77996 09/01/13 09/01/14 oo�i�v iN.iuRv�Pe�ua,so„� y
, � -� ALLOWNED � SCHEDUL�D __ .._
_. AUTO.`> _X AUTOS RODIL Y IN,II IRY(Per arridant) '�
fdON-OWNFD
X HII?Ef'NJIOS X q���0� PROPFRTYDAMAGF $ �—-�-
- �- Per accident _
$ ------
X UMBRELLA LIAB X �C�.��P EACN OCCURRENCE 2 S,OOO,OOO
- --------- -----
/� ExCE55 UAB c�t�iMs MA�E X77996 09/D1/13 09/01/14 A��PE�ArF g 5,000,000
UEU HtIENIIUN$ � �—�---
WORKERS COMPENSATION WC ST�TU- pTH-
AND EMPLOYERS'LIABILITY X TORY IMI7" _,.GR__
A nNv rrz r Fir�ror�iPnFzrniER�;ecuTive Y�� X77996 09/01/13 09/01/14 �
��FRCER/f1EMBER E<CLUDED� � N�A E L EACH ACCIDENT_ $ SOO�OOO
(Mandalory in NH) E L.DISEASE-EA EMP�OYEE $ rJ0���0�
If yes,desa�ibe under
DESCRIFTION OF OPERATIONS below EL.DISEASE-POLICY�R•AfT $ SOO,OOO
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEMCLES (Attach ACORD 101,Additlonal Remaiks Schedule,i(more space Is required)
CERTIFICATE HOLDER CANCELLATION
ORONO-3
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Orono THE EXPIRATION DATE THEREOF, NO710E WILL BE DELIVERED IN
ACCORDANCE WITH THE POUCY PROVISIONS.
P.O. Box 66
Crystal Bay, MN 55323 AUTHORIZEDREPRESENTATIVE
/,+J_t`_'. (� _�"'�—/.-__-_.
G'
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
rKuruacu t�cvniivns
+ , . �. Garage Ftow ot drive = 951.50 ' XXX.� Denotes Proposed Elea
Top of Goraga Foundation = 951.90 c' ' XXXX Denotes Ezisting Efevol
T of Foundotim = 952_40 � � --� Denates Surface�rainc
� Top of Found. SET - 957.15 Gy�, �-�`g`,�-�` ' - �7 _ Denotes Offset Hub or
Top of Found. ot SEZ (LO}= g45.65 � �. � ��!' � Denotes Droin. and Uti
Lowest Floor = 942.44 /`�p �� �� • Oenotes IAonument Fa
' ��.2 j -9�� O Denotes Monument Set
AREAS&HARDCOVER / `� �O� � ' --9�--'Omotes Ezisting Conto
Lot Area = 18,451t sq. ft. � �.� ��� _ g5y/", 864 Denotes Proposed Cont
OOG�'J� Denotes Propwed Boul
Max. Hardcover Allowed = 25X= 4613 sq. ft. /9�' / '% � �
�O / —SF—Denotes Silt Fence
/ ` J' /
Pr000sed Hardcover / �k j � 95� / '- �- Denotes Coniferous Tre
See Hordcover Caiculotion Worksheet for details _
7otol ?roposed Hardcover= A6i0 sq. ft. = 24.99% / ry� � _ ,� �{�1 �9g0� � Denotes Deciduous Trei
�h `� �
SETBACKS / / �A_ Denotes Remove Tree
Averoge lake setback of adJxent homes = 110 feet / �� � __ �� � �
Proposed lake setback = 121 feet � A' 1 9/ '
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BENCHMARK �
T of fron P e as shown. PROPOSED 40'-7�" , E
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NOTE: E)OSTtNG WhLLS WITHIN 75 FEET FROM L . �\� 9���_ + \g ^ �\ '
LAKE WILL BE RECONSiRUC7ED WITH 80ULDERS RF4p �/�ri�.\� �9.�Z 3)� �
TO 7HE DCISTING ELEVATIOPIS AS SHOWN. �c� ��
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CERI'IFICAI'ION e ! 9 .g S\ ��� ti2 P � The [ast line of Lot
I hereby cuti'y that this plan, speciNcat�ai, or report Kos � '�F(i 9,� � ORCHARD BEACH is
prepared by me or under my direct supavisim ond that I J � � 31;2 \ assumed to bear Sc
� am q duly Licensed Lond $urveyur under the lows of the � � ��9�,
State of Minnesota. �//y ��,,� � � (` 0
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Curti�ss J Kdlio, Lic. No. 26909 Date � 4 �
KAI.LIO Engineering �nc. �KE MINNETONKA \��\�
WATER ELEV. 928.6 AS OF 10/11/i3 � �
10775 Poppitz Lane OHW IIf.V. 929.4 FT. (NGVD29, fROM DNR) �
� Chaska,MN 55318 HNt 930.5 FT. ON 9/7/02(FR01A�NR) �
�- � � J
DAT� TIME
CITY OF ORONO CALLED IN �- _ �
INSPECTION NOTIC SCHEDULED
PERMIT NO. � ��'S� CON4PLETED
ADDRESS �✓��S
OWNER L HONE NO. oYS" 7
CONTRACTOR
�; DESCRIPTION C�%�� � �`�`--� ry
�
l� ❑ FOOTING 0 PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL �MECHANICAL RI ❑ LAKESHORE/WETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
i ❑ DEMO-FINAL ❑ SEPTIC INSTALL � HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
Z OWNERICONTRACTOFi TO MEEf YOU:_YES_NO �
° COMMENTS: .Su.��I�.Q� �t- rv���n-S ' b
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� ❑W SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE CO'VERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call " ion 24�ours in advance. (g52) 249-460�
Owner ntractor on site: �
inspector. �
White Copyllnspector's File Canary CopylSite Notice
�`� � DATE TIME , /
V
CITY OF ORONO CALLED IN --�—��-�-
INSPECTION TIC SCHEDULED T_��� o"sZLl
PERMIT NO�� "'���5! C PL6ZED
ADDRESS l U
OWNER 'TELEPHONE NO.� � �g�7
CONTRACTOR r
� DESCRIPTION —
�
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EX V/G ADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAK FJWETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNbATION/REMOVAL
Z OWNERfCONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ❑WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WFLL RETURN
❑CITATION ISSUED
❑STOP ORDEH POSTED.CALL INSPECTOii
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 ho rs in advance. (95 49-46��
OwnerlContractor on site: _
Inspector.
White Copyllnspector's File Canary CopylSite Notice
� �� DATE TIME �
CITY OF ORONO C�cAL�ED IN
INSPECTION NOTICEI/. --7 scHeou�Eo �
PERMIT NO. I V —DD /S�COMPLEfED
ADDRESS � � � � �rl/ '�c
OWNER TELEPHONE NO. / ��
CONTRACTOR ��/��l�D /¢-�/�
� DESCRIPTION ���� h� � Y
ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
� ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI, ❑ SITE INSPECTION
Q ❑ FRAMING ME 6A�-FIAIAL�� ❑ PROGRESS
� ❑ INSULATION WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
v ❑ DEMO-SITE ❑�TIC INSTALL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTO TO MEET YOU• YES_NO
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W ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE
� C RECT WORK 8�PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
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Cail for the next inspection 24 h urs in a 52) 249-4600
OwneriContractor on site:
Inspector.
,
White Copyllnspector's File Canary CopyfSite Notiee