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� CITY OF ORONO * Z pJ 1 6 - 0 1 0 7 6 *
2750 KELLEY PARKWAY DATE ISSUED: 09/0112016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1209 FRENCH CREEK DR
PI[� : 10-117-23-23-0002
LEGAL DESC : FRENCH CREEK
: LOT 002 BLOCK 001
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : COOLING SYSTEMS
VALUATION : $ 4,300.00
NOTE: (1)DAIK[N COOLING SYSTEM
APPLICANT MECHANICAL 53.75
CENTERPOINT ENERGY STATE SURCHARGE MECH(VALUAT[ON) 2.15
6161 GOLDEN VALLEY RD MAIL-IN FEE 2.00
BUILDING A TOTAL 57.90
GOLDEN VALLEY, MN 55422- Payment(s)
(763)512-2765 CHECK 20520 57.90
Minnesota State License#: mech-MB003503
OWNER
JACOBS, MELINDA
1209 FRENCH CREEK DR
WAYZATA, MN 55391-
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
State Building Code. This permit is for only the work described and does
not grant permission for additional 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 I 80 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time tor due cause.
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Applicant Permitee Signature Date I ue Signature Date
�, �'. RECEIV�'�
fY USE ONLY
City of Orono ��p �� �� ) �+. ,�n/ �
�O�O P.O.Box 66 D�te''R�c�Wed 'ermit# �/�-+�{
2750 Kelley Parkway
Crystal Bay,MN 55323 (;�� FA���}�: Amount$: �/
Phone(952)249-4600 Fax(952)249-4616 ���v
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!qk£SH��� CITY OF ORONO—MECHANICAL PERMIT
(All Commercial permits must be approved by the Buildino OYficial 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 revicw is completed. PERMITS ARE NOT
VALID UNTIL YOU RECENE A PERMIT. WORK MUST NOT BEG[N UNT[L THE
PERMIT CARD IS POSTED ON THE JOS SITE.
3. Mechanical Desi�—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 )
� Residentia] ❑ Commercial (Approval Required) [Backflow Device: ❑ AVB ❑ PVB]
❑ New ❑ Additional ❑ Repairs ❑ Replace
Job Site/Owner Information:
Site Address: 1209 FRENCH CREEEK DRIVE, ORONO
Owner: MELINDA JACOBS Mailing Address: 1209 FRENCH CREEK DR
City: WAYZATA , MN Z�p: 55391
Home Phone: 952-473-1071 Alternate Phone:
Contractor Information:
Contractor: CENTERPOINT ENERGY Contact Person: JOANN ZINKEN
AC�dI'eSS: 6161 GOLDEN VALLEY RD,BLDG A State BOnd #: MB003503
Clty: GOLDEN VALLEY Zlp: �`/�N EXpll'ah011 �ate: 08/20/2018
Pl1011e: 763-512-2765 Alternate Phone:
OLD REPUBLIC INSURANCE C0.
❑ WORKERS COMP 8 EMPLOYERS LIABILITY
InSUCalICe—CUCCe17t. POLICY#WLRCC48597075
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MECI�ANICAL 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:
Model:
Fuel:
Flue Size:
[nput BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity: � —_—_.— _—
Make: DAIKIN
Mode(: DX13SA0421
Tons: 3 1/2
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) cfin
❑ No. Other Fans: Locations cfm
FUEL STORAGE (Must be approved by Fire Marshall i,f 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:
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PERMIT FEE CALCULATIONS
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00)
4300.00 x.Ol 25 $ 53.75
(contract price) (minimum$50.00)
2. STATE SURCHARGE
4300 00 x .0005 $_._ 2 15
(contract price)
3. POSTAGE& HANDLING (Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 57.90
■ * CONTRACT PRICE or JOB COS'I' 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 for issuance of a Mechanica] 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: pg/22/��,
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