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CITY OF ORONO * 2 0 1 4 - 0 0 5 9 7 *
- 2750 KELLEY PARKWAY DATE ISSUED: 06/13/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 35 GOLDEN VIEW DR
PIN : 33-118-23-43-0010
LEGAL DESC : PETERMAN 2ND ADDN
: LOT 001 BLOCK 001
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL- MULTIPLE
VALUATION : $ 6,400.00
NO`I'E: 1 CARRIGR NAT GAS EURNACL;S
l CARRII:R 2.5"1'ON AC
APPLICANT MECHANICAL 80.00
STATE SURCHARGE MECH (VALUATION) 3.20
CENTER POINT ENERGY MINNEGASCO MAIL-IN FEE 2.00
9320 EVERGREEN BLVD NW
SUITE B TOTAL 85.20
COON RAPIDS, MN 55433 Payment(s)
(763)757-6202 CHECK 18509 85.20
OWNER
ANDERSON, M & K
35 GOLDEN VIEW DR
LONG LAKE, MN 55356
AGREEMENT AND SWORIV STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specitications,applicable City approvals,and the
State E3uilding Code. This pem�it 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 Uiis rype of work
shall be compied with whether or not specitied herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date oY issuance,or if construction is
suspended for a period of 180 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.'l�his permit may be
revoked at anv timc for due cayse.
/ /
Applicant Permitee Signature Date Issued B S' nature Datc
. . . �
' FOR CITY USE ONLY
i'�� City of Orono
. i� �► �^ � P.O.Box 66 Date Received: Permit#
V � 2750 Kelley Parl.�vay
' ; Crystal Bay,MN 55323 Approved By: Amount$:
� Phone(952)249-4600 Fax(952)249-4616
f� ` �r
`' CITY OF ORONO-MECHANICAL PERMIT
`�k�SH°�� (All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall)
GENER.AL 1NFORMATION
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 NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical DesiQns—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 wark must be done in accordance with the Uniform Mechanical Code/State Building Code
requirements.
6. All work must be inspected(rough-in and fmal). 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: 3� ����n V�' � ��-
Owner:�r�r�. ���e-�SDY� Mailing Address: 35 �'oo L c��er� V �e-w alL
City: �orp � �1� 5535� Zip: �5S 3S L
Home Phone: QS a'�1�S • 6�33� Alternate Phone:
Contractor Information:
Contractor: CENTERPOINT ENERGY Contact Person: JOANN ZINKEN
Address: 9320 EVERGREEN BL NW State Bond #: MB003503
SUITE B
City: COON RAPIDS Zip: 55433 Expiration Date: 08/20/2014
Phone: 763-785-5404 Alternate Phone:
� Old Republic Insurance Co.
IriSl1T'1riCe—CUTTerit: Workers Compensation&Employers Liability
1 Policy#WLR C47875717
Policy Period O1/O1/2014 to O1/O1/2015
" . .
.
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: �,,f r��r'
Model: ��(��„�t `�O"�y ��'
Fuel: N�� Coc�
Flue Size:
Input BTUs: � �C� � U Op
Output BTUs: �S�00 O
CFM:
COOLING SYSTEMS
Quantity: �
Make: l�r r � �('
Model: ���a
Tons: 01.`�Z
H.Power
FIREPLACES
❑ Gas Factory Fireplace Brand Name:
❑ Wood Burning Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Masonry
V
VENTILATION
❑ No. Kitchen Exhaust duct recirculating cfrn
❑ No. Bath Exhaust(must have duct outside) cfin
❑ No. Other Fans: Locations cfrn
FUEL STORAGE (Must be approved by Fire Marshall if 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:
2
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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:
l. Does not require modification to electrical or gas service.
2. Has a total cost of$500.00 or less;excludinQ 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 contract price with a(Minimum Fee of$50.00)
��-IbO. 60X .oi2s $ �SU • oC�
(contract price) (minimum$50.00)
2. STATE SURCHARGE
��{00 , O 0 X.000s $ 3 . aC�
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �S , �U
■ * 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 af a signed copy of the acrsal cont:act.
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.
` �y
Applicant's Signature: " Date: �v/9
3
S�� _ Qq TIME �
CITY OF ORONO CALLED IN 1 �
INSPECTION NOTICE SCHEDULED -
PERMIT NO.Zo��— ��54 7 COMPLETED
ADDRESS �5 GO��V�E'� �'V�
OWNER ��' ���tiTELEPHONE NO�/Z O/ �S��(
CONTRACTOR
>`; DESCRIPTION r�'�`Yn�Ce `� 1��
�
� ❑ FOOTiNG ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
,� ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
y O 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 O SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
��-f'tEI�ABING RI SEPT L ❑ FOUNbATION/REMOVAL
2�WNE ONTRACTOR TO EET YOU: Y _NO
� COMMENTS:
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W ❑WORKSATISFACTORY:PROCEED ❑ P ECT COMPLEfE
� ❑CORRECT WORK&PROCEED SUE CERTIFICATE OF OCCUPANCY
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� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WIIL REfURN
❑STOP ORDEH POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 ho in advan (95 249-4600
OwnerlContractor on site:
Inspector.
White Copyllnspector's File Canary Co ISite Notice
C terPoint,
House heating test record En `!''`D
C JUN 25��14
11y�FoR
Owner ���� Cantrols Conversion D/v�
I
Address 3 j C-7vI G{-e vi U`te�Pt �j�r, rhermost�(�� Heat p/ug Vent Size � � �
City d�(0 �0 l/a/ve �j 1i3
�,c} Kind of liner/size
Heatloss Datehtg.inst jp j8 �� Limit }.- ��x�C Drahhood���l,t[�egu/ator ;��(
Soldby CenterPoint Ener Limitsettin ° �
__ 9Y g ( C Filters:Size ��p Ko?.�X�-(Number
Installed bv CenterPoint Energy Fan setting ���.e Chimney locations: (�'Inside Q Outside
E/ectrical work bv CenterPoint Energy Piloi type �� Chimney construction �j'
Heat type �'FA Q Space heater Pilot make �`' Wiring �j Test tag 1/
Gas line by ('JJ P Pilot model � Lighting Inst y� Date tested (,��lg %y
Unitheater Other Pilottiming I� �'L CompanytestinQ CenterPoint Energy
Gas design
Pressure:Hi fire¢�e#rre— 3, y� i�1�1L Tester's name �l(CC�" d��5
Percent CO2 �q I%p ,�C�C—3 �
Make�Cc i�YI.��� Mode/S$�I�1�-�})](7—(�p
Seria/no.�3 I,3 I��a 3�C Input CFH Percent Oz 7i��
Input , (�,d�(� Stack temp��%�� Percent CO �?�Aw
—�
CNP 235(11-2008)