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� CITY OF ORONO * z 0 1 5 - 0 1 1 6 1 *
2750 KELLEY PARKWAY DATE ISSUED: 09/1U2015
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2630 FOX ST
PII� : 04-117-23-42-0009
LEGAL DESC : REG. LAND SURVEY NO. 1249
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RES[DENTIAL
CONSTRUCT[ON TYPE : HEATING SYSTEMS
VALUATION : $ 3,703.00
NOTE: 1 HEATING SYSTEM REPLACEMENT(AMANA)
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH (VALUATION) 1.85
BONFE'S PLUMB[NG, HEATING&AIR MAIL-IN FEE 2.00
505 RANDOLPH AVE
ST PAUL, MN 55109- TOTAL 53.85
(651)287-2237 Payment(s)
Minnesota State License#: PLUM-058395 CHECK 37226 53.85
PM,mech-L09836613
OWNER
SARENPA,ANTHONY&NICOLE
2630 FOX ST
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for 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 w�fhin 180 days of the date of issuance,or if conswction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspec[ions are ''
requested in conformance with the State Building Code.This permit may be _ ������
revoked at any time for due cause. -- -
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Applicant Permitee Signatupre � Date Issued By Signature Date
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F'OR C1TY UST ONLY 1'�I I
f�O A}�,� City of Orono c /����.-�.
�VO\ P.O.Box G6 Date Received: 1=�:.I�erntit#
�' 2750 Kelley Parkway �� �/� i �/�'
i 1� Crysial Bay,h4N 55323 Approved By: 1� 1 ) Amount$:�
i Phone(952)244-4600 Fau(952)249-4616 �'�4 i
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�����ESHo¢j' CITY OF 4RON0-MECF�ANICAL PERMIT
��-�__ (All Commercial permits must be approved by the Building O�cia(or lnspector and/or Fire Marshnll)
GENERAL INFORMATI4N
3. You may apply for mechanical permits by mail or in person at the City offices. Applications wil]
be reviewed and a permit�uill be issued within two worl�ing days.
2. Permit cazds will be sent by retarn mail after a review is compleied. PEItNfITS ARE NQT
VALID UNT[L YOU RECEIVE A PERMIT. WORK MUST N�T BEGII�1 UlYTIL THE
PC;RMiT CARD iS POSTED ON'TEIE JOB SiTE
3. Mechanical Desi�ns—Compiete calculations,details and specifications are required for each
heating,ventilation,hunzidification-dehumidifeatioa,and air conditioning installation including
heat loss/lieat gain calculation,design temperatures,equipment ratings and identitication as to
type,n=anufacturcY and model. Data shall bc presenced on fonn provided.
4. When any new constructioa or remodeling is involved,a separate buiiding permit must be
obtained.
5. All work must be done in acc:ordance with the Uniform Mechanical Code/State Building Code
requirements.
6. All work musi be inspected(rough-in ar�d final). Cal((952)2�19-4600.
(24-48 hour notice required}
7. House Heaiing Test Record must be submilted before fival.
TYPE OF PERMIT
Check All That A I
Rcsidential ❑Commercial(Approval Required)
❑New ❑Additional ❑Repairs �piace
Job Site/Owner Information:
Site Address: __ UI � 3p ��i ��� ��
Owner��
� Mailirig Address: ��c�f��,� ��
City: ��"�l� Zip: s�.r��?�___
Home Phone�.������� Alternate Phone:
Contractor Information: -----��A�-I
.---
Contractor: _JC��,�_l�'�� Conta.ct Person: ��� �� �
Address: � �/ /��ate Bond#: ���`���
�."— � �55/0.�p �s:?��
Ciry: �-1� Zip: Ex iration Date:
Yhone: ��/=�t'�� ��J�� Alternate Plione:
❑ Insurance-Current:
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' MECHANICAL;'�YSTEMS BEING INSTALLED
Note: Ail Geothermal Systems will now require a Site Plan&Review by our Building Offcial.
IS THIS GEOTHFRMAL:� ❑ Yes ❑No
HEATING SYSTEMS
Quantity: �
Make: ����� - ---- --
l�iodel:
}�uel:
Flue Size:
Input f3TUs: �_(�Q�Q�� _
Output B`CUs:
CFM:
COOLII�G SYSTEMS
Quantity:
Make:
Model:
Tons:
H.Power
FIREPLACES
❑ Cias Factory Fireplace Brand Name:
❑ Wood$urning Fireptace
❑ Mood Stove l�todel No.:
❑ Wood Stove with Flue/Masonry
VENTtLATiON
❑ No. _ Kitchen Exhaust duct recircufating v___cfm
� No. Bath E�:l�aust(must have duct outside) cfm
No. Other Fans: Locations ��
FU�L STORAGI�: (Mt�st be approved 6y Fire Marsllall if propasi►rg to abandon tank in pince.)
❑ lnstallation ❑ Removat
Fuel Oil: _gallons ❑ UnderDround ❑Inside ❑Outside
LP Gas: galtons
Other:
GAS LiNE ONI,Y
❑ Outdoor Grill ❑ Other!List What&Where:
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-- PEIZMTT'�EE CALCULATION(S)
__ .Bt�SED O#�F-2002 �TATE �TATI7E
❑ Yes,this sec4on applies
Thc replacemenY of a Residential fixture or appliance that meets all three of the following reqniremertts:
1. Does not require modification to elecirical or gas service.
2. Has a total cost of$500.00 or less;excludin�the cosi of Tlie fi�ctute or appliaace:and
3. ls improved,installed or replaced by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surcharge $ 1.00
Mail-In�'ee(IfApplicable) $ 2.00
Total Permit Fee S
( �PERMIT FEE CALC�LJLATIUN{S}-TpBS�'jVER$500.00
If above does not apply;foliow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
�=��7.r~i� X.o E 2s$ _
(contract price) (minimum 550.00)
2. STATE 5URC�IARGE
x.0005 $
(cootract price)
3. POSTAGE&HANDLING(Ority on Mail-ln Apptications) $ 2.00
4. TOTAL['ERMIT FEE(Add Lines 1-3 Above) $ ��,��
� * CON7'RACT PRTCE or JOB COS�'means the actual or estimated doltar arr�ount charged for the
perniitted work including materials, labor,profit,and other fixed costs. It is thc amonnt to be charged
to the customer for the work done. If any material, equipment, labor or installations are fumished by
the owner,tenant or any other party, the reasonable market vafue of such items must be added to the
estimated cost or contrae;t price for pernut fee purposes. ln the event that there is a dispute on the
amou�t of the job cost, Yhe City �nay request the submission of a signed copy of the aetual contract.
. MEGI�ANIGAL P�R1�IT A�'PLTCATION AGREEMENT
The undersigned hereby applies to the City for issuance of a Mechariical Perm'tt, agrees to do all
work in strict accordance with the ordinartces of the City and ihe regulations af the State of
Minnesota, and certifies that ail statements made on this application are complete, true and
correct.
Applicant's 5ignature: �J ��� Date:_l�����
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