HomeMy WebLinkAbout2016-00372 - gas line only f CITY OF ORONO * Z 0 1 6 - 0 PJ 3 7 Z *
2750 KELLEY PARKWAY DATE ISSUED: 04/14/2016
ORONO, MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 155 GOLDEN VIEW DR
PIN : 33-118-23-43-0014
LEGAL DESC : PETERMAN 2ND ADDN
: LOT 005 BLOCK 001
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : GAS LINE ONLY
VALUATION : $ 2,200.00
NOTE: GASLINE FOR STOVE AND FIREPLACE
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 1.10
JOE'S PLUMBING&HEATING MAIL-IN FEE 2.00
23375 DRAKE ST.N.W.
ST FRANCIS,MN 55070- TOTAL 53.10
(763)427-7132 Payment(s)
Minnesota State License#: BUIL-060783-PM CREDIT CARD 7726 53.10
OWNER
SMITH,DOUGLAS
155 GOLDEN VIEW DR
LONG LAKE,MN 55356
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 within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time afrer 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 for due cause.
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Applicant Permitee Signature Date Issued ignature Date
04/13/2016 19:�8 FAk 7634271647 JOESPLUMBINGINCAO f�002/O10
F GI , USE,ONLY`'
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Cryetal6sy MN553�3 Approv�tlBj!9'� �I�����;,, �.AR'poupt;�&: ��:,�'
Phane(952)249-4644 Fax(952)249-4616 �'�'��,',�''� ��i'�',%
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�''��sHo��G �ITY OF ORONO—MECHANICAL ��RMIT
(All L'ommcrcial permits must bc approvcd by chc Auilding OfFicial or Inspcctor�nd/or Pire Marshall)
��'�� ������iil'�iQ��� � � ��' � I I,��;I�;�;i�; "-�,�'� �
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l. Xou may apply for mechanical permits by mail or in person a�thc City offices. ApplicAtions will
be re�iewed and a permit will be issued wiChin two working days.
2. Permit cards wi]!be se�t by return mail after a review is completed. P�RM1T5 AftE NOT
VALID UNT1L YOU RECEIVE A P�R,MIT. WORK MUST NO'Y'$�CIN UNTIL THE
PE�,tMIT CARD IS POST�D ON THE JOB Si7'E.
3. M�chanieal D 4i . —Complete calculations,details and speeifieations arc required for each
heating,ventilstion,humidificacion-dehumidificatipn,and air conditioning installation includx�ng
heat loss/heat gain calculation, design temperatures,equipment ratings and identification as to
type,manufacturer and model. pata sha{I be presented on form provided.
4. When any new construction or remadeling is involved,a se�arate building permit must be
obtained.
5. All work must be done in aeeordanee with the ilniform Mechanical�ode/State 13uilding Gode
requirements.
6. All work must be inspected(rough-in and fin�l). Call(952),.'2,�19`.-;3�00.
rY7k
(Z4-48 hour�otice required) � s. .
7. House Heating�'est�ecord must be submitted before fina4��,:����-_',�°ti,� '
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p��!i�, ,.. '�,�,�'� , T`�PE OF PE1�I: p'.d � .I�r;` ;;��;� �� ,,, i„:,.�;�, ,
�'�'� , �� � �,'ii��':� � , �� ��i ' ,:�R."��'�!�„5��,;.��I�.��!�r��.. ';�,'�'�;',',.�;'�,;��;�.; '';I��i,';i'A�.,n,,�.�;i,�,
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�r�, �! ,Gh"ec1�,E411 Tlla'C A.' 1 q,�����"' �t,�°M:. ' •� ;r;',��'��`,,,;,i,�„�;�,r',,;;;,�,,,,,
�Re
sidential �Commerc�al(Approval Requued) [BAekflow Dcvice: ❑qVB []pVB]
�NeW [�Additional ❑Repairs 0 Replace
�.Ja��i}�;,�;�'j�'�M;';�i�rm�tio�:; ,
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Site Address: -�
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Owner: �OIC`�5�,� Mailing Address: �` � '�'��� � '
:�:� .
City: Zip:
Home Phone: Alternate Phone: `
�Cantractb�-�foiniati"an: ,, !
Contractor: ` � �' � Contact Person:
Address: Z.3��� C(�La,_�.C-�StateBond#: _ '�--)
City: ` Zip�'�� Expiration Date:
Phone: "7(���`-��7-�1�� Alteznate Phone:
❑ insurance- Current: �+����
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04/13/2016 19:58 FAX 7634271647 JOESPLUMBINGINCAO C�003/O10
Note: ,A.la Geothezmal Systems will now require a Site Plan &Review by our Building Official.
IS THIS GEOTHERMAL7 ❑ Yes ❑No
H�ATING SYSTEMS
Quantity:
Mak@;
Model;
Fuel:
Flue Size:
Input BTUs:
Outpu[STUS:
CFM:
COOLING SYSTEN�S
Quantity:
Make:
Model:
Tons:
H.Power
F��EPLACES
� Gas Factory�ireplace Brand NAme:
Wood Burning Fireplace _ :
❑ Waod Stove Mudcl No.=
❑ Wood Stove with Flue/Masonry
VEITILATION
❑ No. Kitehen Exhaust duct reeireulating cfm
� No_ Bath ExhAust(must havc duct outside) cfm
❑ No. Other Fans: Locations cfn,
FC�iEL STORAGE (Must be approved by Frre MdrshaU if propasing la abandon tank in place.)
❑ Installation ❑ Removal
�uel dil; gallons ❑ Undergrvund ❑Inside ❑Outside
LP Gas: gailons
Other:
GAS LINE ONLY
❑ Outdoor Grill � Other/List What&Where:�'i�L�-`Z �Q���
/
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04/13/2016 19: 58 FAX 7634271647 JOESPLUMBINGINCAO Qj004/O10
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1. CONTRACT PRICE � is 1.25%of contract price with a(Minimum Fee of$30.00)
L � x.0125 � �'`� .
(c �rac�pricc) (m7nimum 550. 0)
2. STATE SURCHARGE � � � � ' O
x.0005 �
(con c�pricc)
3. POSTAGE&HANDLING(Only on Mail-]n Applications) $ 2.00 _
4, TOTAL PERMIT FE�(Add Lines 1-3 Above} $
■ * CONTRACT PRiCE or JOB COST means the actual ar es�imatcd dollar amount charged for the
permitted work including materials,labor, profit, and other fixed costs. it is[he ampunt to be charged
to the customer for the work done. if any material,equipment,labor or installations are fitrnished by the
owner, tenant or any orher party, the rcasonable mar.ket value of such items must be added to the
estimated cost or contract price for pernlit fee�urposes, ln the event that there is a dispute on the amount
of the job cost, the City may request the submission uf a signed copy of the actual contract.
The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all
wor�C in strict aceordance with thQ ordinances of the Ciry and the regvlations af khe State of
Mi�nesota, and certifies that all statemen:s made on this application are complete,true and correct.
Applicant's Signature: Date:
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