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Home My WebLink About2012-01116 - mechanical �� CITY OF ORONO * z 0 1 z - 0 1 1 1 6 * � 2750 KELLEY PARKWAY DATE ISSUED: 1 UO2/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2365 GLENDALE COVE LA PIN : 34-118-23-33-0068 LEGAL DESC : GLENDALE COVE : LOT 009 BLOCK OOI PERMIT TYPE : MECHANICAL(>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : MECHANICAL- MULTIPLE VALUATION : $ 12,000.00 NOTE: I TRANG NAT GAS FURNACE 1 RENEWAIR AIR TO AIR EXCHANGER 1 TRANE 3 TON 1 KITCHEN EXHAUST GAS LINE-MAIN-FURI�ACE APPLICANT MECHANICAL 150.00 RAY N. WELTER HEATING CO STATE SURCHARGE MECH (VALUATION) 6.00 4637 CHICAGO AVE MINNEAPOLIS, MN 55407- MA[L-IN FEE 2.00 (612)825-6867 MISC FEE 0.00 TOTAL 158.00 OWNER BARNIER, STEVEN P 2365 GLENDALE COVE LN LONG LAKE, MN 55356- AGREEMENT AND SWORIY STATEMENT "I�hc work for which this permit is issued shall be perfbrmcd according to the approved plans and specifications,applicable City approvals,and the Statc L3uilding Code. This permit is for only the work described and does nut grant permission for additional or related work which rcquires separatc permits. All provisions of�laws and ordinances governing this type ofwork 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 iC construction 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. `�Z�c--lc'�-� � l l l l Applicant Permitee Signature Date Issued By S' ature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A E. ' ' �- FOR CITY USE ONLY ,�0� City of Orono � � P•O.Box 66 Date Received: Permit# ;y,;,Y,�, 2750 Kelley Parkway a '� '�,� a� C stal Ba MN 55323 A roved B Amount$: � `' , ti rY Y, PP Y� �� '��j��',;j�.o` Phone(952)249-4600 Fax(952)249-4616 � �&pA08� CITY OF ORONO —MECHANICAL PERMIT (All Commercial permits 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. Perxnit cards will be sent by return 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 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 auy new construction or reinodeling 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. Ail 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 Apply) �esidential ❑ Commercial(Approval Required) (�New ❑Additional ❑Repairs ❑ Replace Job Site/Owner Information: Site Address: Gr ��'s �C,(��. ��L.fi�� Owner: ti � `/��l� � (�YYI L j �Mailing Address: •�l� ' / �U� c�ty: ��r5c.��;!l� � � z�p: SSD�� Hoine Phone: ��' ��/-' `�"�� Alternate Phone: � Contractor Information: Contractor: ; �� L�'�, ��, Contact Person: ��VL,I Address: `7��'/ ��(� �/��,v �1�� State Bond#: �M I�(�U,,3 I h� City: � ' S. Zip:�v�Expiration Date: �'� �- ��{ Phone: ��o�' �� b4c�� Alternate Phone: " ❑ Insurance—Current: �-j� 1 f MEC�AI�ICAL SYSTEMS BEING INSTALLED Note: All Geothermal Systems will now require a Site Plan &R�view by our Building Official. IS THIS GEOTHERMAL? ❑ Yes �� HEATING SYSTEMS Quantity: __�_ ! Make: ��,J� I\L��i1�1��`.• Model: IG1�II(� �� /ZC..��L� Fuel: ►�/E (.,�'f� Flue Size: 3 �� / , �/�� Input BTUs: l/� �� Output BTUs: CFM: COOLING SYSTEMS Quantity: + Make: G Model: % ��.�� Tons: � H.Power FIREPLACES ❑ Gas Factory Fireplace Brand Name: ❑ Wood Burning Fireplace ❑ Wood Stove Model No.: ❑ Wood Stove with Flue/Masonry vENTi�.a�riuN �?,��/�2 _�iZ�'�12�' �� 7l1��%i, �G�a�n.�Gce.�y� [� No. � Kitchen Exhaust ' duct recu-culatin cfm g � ❑ No. Bath E�aust(must have duct outside) cfm ❑ No. Other Fans: Locations cfm FLTEL STORAGE (Must be approved by Fire Marshall if p��oposing 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 8r,Where: 1 A� — �'�1/Z,1�/�FC� ' I vl L��,c2 �i� �'/wt��?�ti 2 �U�� {i��'G�d� PERMIT FEE CALCULATION(S) � � � BAS�D (JFF - 2002 STATE STATUE � I ❑ Yes,tliis section applies The replacement of a Residential fixture or appliance that meets all tlu•ee 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 fixhire or appliance: and 3. Is improved, installed or replaced by the homeowner or licensed conh�actor. 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)=70BS 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) ,7� aJ /!/1 i l/vV �� G>�i x .0125 $ ��j�� `'" — (contractprice) (minimum$50.00) 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$5.00) l, ��/C'�� x .0005 $ L� (contract pnce) (minimum$5.00) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 �� 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��'f ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted 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 cosi, the City may request the submission of a signed copy of the actual contract. ■ ** The STATE SURCHARGE is .0005 tunes the Contract Price or a minunum 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. • Applicant's Signature: Date: ��+ 3f-'/v� 3 �11htNE54Th DEPItiRTFdENT¢F � �.a�o� & ��vousrRr MECHANICAL CONTRACTOR BOND a Construction Codes and Licensing Division Licensing and Certification Services 443 Lafayette Road N St.Paul,MN 55155 Website: www.dli.mn.aov/ccld.asp Email: dli.licenseC�state.mn.us Phone: 651.284.5034 This is to certify that the certificate holder is registered as a MECHANICAL CONTRACTOR BOND in thc state of Minnesota and is in compliance with Minnesota Statutes 326B.197,and has filed a$25,000 mechanical bond to perfornl gas,heating,ventilation,cooling,air conditioning, fuel burning or refrigeration work in all areas of the state during thc registration period;provided the work performed complies with the State Mechanical Code and the certificate holder maintains compliance with the required bond and workers'compensation laws. Registration : MECHANICAL CONTRACTOR BOND � RegNumber : MB003163 RAY N WELTER HEATING COMPANY � Effective Date : OS/21/2012 4637 CHICAGO AVE S B Expiration Date : 08/21/2014 MINNEAPOLIS, MN 55407 � T VERIFY UP-TO-DATE STATUS, BOND,AND INSURANCE INFO ATwww.dli.mn.qov/ccld/LicVerifv.asp (ENTER NUMBER). , A`�� CERTIFICATE OF LIABILITY INSURANCE ei3i�2o��' 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 CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT C@Lt1f1C3t2S De artment NAME: P Kraus-Anderson Insurance PHONE (9S2)�IO7-B2OO q/C No: (952)690-0535 420 Gateway Boulevard EpA�� .Certificates@kainsurance.com INSURER S AFFORDING COVERAGE NAIC# �Burnsville MrI 55337-2790 wsuReRn:Cincinnati Insurance Com anies �INSURED INSURERB AI[1221C3I1 Com ensation Ins. Co. 45934 �Ray N Welter Heating Company INSURERC: 4637 Chicago Avenue INSURERD: I . INSURER E: ?Minneapolis MN 55407-3512 INSl1RERF: COVERAGES CERTIFICATE NUMBER:12-13 Certificate REVISION NUMBER: THIS IS TO CERTIFY 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 SI-IOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE ADDL SUBR pOLICY NUMBER MM/�DYIYYYY MM/DD/VYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1�OOO�OOO X COMMERCIALGENERALLIABILITY PREMISES Eaoccurrence S SOO,OOO A CLAIMS-MADE �OCCUR PP0099789 9/1/2011 9/1/2014 MEDEXP(Anyoneperson) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PR� LOC $ AUTOMOBILE LIABILITY COMBWED SWGLE LIMIT �.� Eaaccident $ 5�� , X ANY AUTO BODILY INJURY(Per person) $ ��'A ALLOWNED SCHEDULED BA 009 97 69 9/1/2012 9/1/2013 � AUTOS AUTOS BODILY INJURY(Peraccident) $ � NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Peraccidert $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1�OOO�O00 �..A EXCESSLIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTIONS 0 PP0099789 9/1/2011 9/1/2014 $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY YI N ANY PROPRIETOFLPARTNEWEXECUTIVE E.L.EACHACGDENT $ SOO OOO OFFICER/MEMBEREXCLUDED? � N�A C-WC-005077-1 9I1/2012 9/1/2013 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500 000 If yes,describe under DESCPoPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD'101,Additional Remarks Schedule,if more space is required) RE: All work performed by the insured on behalf of the certificate holder. ( 0 JCERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Orono PO Box 66 27rJ� Kelley P3Z'�CWBy � AUTHORI2EDREPRESENTATIVE Crystal Bay, NIN 55323 Jim Klym/MATTK � � ACORD 25(2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025�zo�ooa�oi The ACORD name and logo are registered marks of ACORD � DATE TIME � CITY OF ORONO CALLED IN I� oZ 7-�� INSPECTION NOTICE SCHEDULED //�� U PERMIT NOP�O/o - � COMPLETED ADDRESS � �.� �� rJ'�LI Lil� � OWNER TELEPHONE NO.�f�-��S-�o��i�7 CONTRACTOR a DESCRIPTION v �l � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL Q ❑ 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. ❑ FOILOW-UP i ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a 0 0 ,� � ��-l-E S � vrL. � � 0 � W � Q � Z W � W � � d W� �VORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK 8�PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITION WITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. �95Z� 249-46QQ OwnerlContractor o�ite: Inspector. _� , � _ v White Copyllnspector's File Canary CopylSite Notice ,� G —� DATE TIME ✓ CITY(�F'Q 0 CALLED IN �'" `� INSPECTION NOTIS� SCHEDULED /�D:/?S � PERMIT NOr��f'�� co PLETED ADDRESS �J��O� �%�LZGx��,.e%J/'C OWNER T LEPHON NO. � o ' � CONTRACTOR � >; DESCRIPTION � C��%L�G(�(' � � ❑ FOOTING O PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL O ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB 0 WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a o f�,a �c� �� fi��' � �t C� a � 0 � W � Q � z W � W � � a W� ❑WORKSATISFACTORY:PROCEED �RQ,IECT COMPLETE W ❑CORRECT WORK 8�PROCEED C ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pH0T0 TAKEN INSPECTOR W4LL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� Z49-46�� OwnerlContractor on site: Inspector. �_:h : �7 White Copyllnspector's File Canary Copy/Sife Notice