HomeMy WebLinkAbout2014-01253 - mechanical � �* CITY OF ORONO * 2 0 1 4 - 0 1 2 5 3 *
2750 KELLEY PARKWAY DATE ISSUED: 10/27/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1510 GREEN TREES RD
PIN : 11-117-23-23-0015
LEGAL DESC : GREEN TREES ON TANAGER LAKE
: LOT 005 BLOCK 001
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : KESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL- MULT[PLE
VALUATION : $ 6,500.00
NO"I�E: (2)CARRII?R FURNACE;S
APPLICANT MECHANICAL 81.25
STATE SURCHARGE MECH(VALUATION) 5.00
APPLIANCE CONNECTIONS, INC. MAIL-IN FEE 2.00
12850 CHESTNUT BLVD
SHAKOPEE, MN 55379- TOTAL 88.25
(952)445-4803 Payment(s)
Minnesota State License#: mech-MB004165 CHECK 5795 88.25
OWNER
STEVENSON, SCOTT
1510 GREEN TREES RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The���ork for which this permit is issued shall be performed according to
the approved plans and specitications,applicablc Ciry approvals,and thc
State Building Code. This permit is for only the work described and does
not grant pennission for additional or related�vork which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not spccified herein.This permit will
expire and become null and void if construction authorized is not
commenccd within 180 days orthe date of 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
reques[ed in conformance with the State Quilding Code."�his permit may be
revoked at any time for due cause.
� �-� /o/i7�� � /a� d7� i�
Applicant Permitce Signature Dat�, �� Issued ,�Signature Date
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CIT U ONLY
� City of Oronp l y�
%�¢ �� P.O.Box 66 Date Receiv . � Permit#s�� �
(���, �� 2750 Kelley Pazkway
l,� .�1�'�r` !►�i Crystal Bay,MN 55323 APProved By: Amount$:
`���A;wyo�y� Phone(952)249-4600 Fax(952)249-4616
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CITY UF 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. Applicarions will
be reviewed and a permit will be issued within two working days.
2. Permit cards will be sent by retum mail after a review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE
P�RMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical ISesi�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 a 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�ork must be inspected(rough-in and final). Cali(952)249-4600.
(24-48 hour notice required)
7. House Heating Test Record r��ust be submiited before final.
TYPE OF PERMIT
(Check All That Apply)
�Residential ❑Commercial(Approval Required)
❑New ❑Additional ❑Repairs �Reolace
Job Site/Owner Information:
,�1��_.._ -�-, �� ��-
Site Address: 1 i� 1> i'�l I Ir S
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Owner�X D�_'1=� �E ,^�,��1S� Mailing Address: C J � ' �
city: (��(�J'1'1 U zip: `��3 � 1
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Home Phone: ���"��I ' �J / U/ Alternate Phone:
Contractor Information: i
O
Contractor: Contact Person: 1� � ''
�►,�lianc� �_ ,��� ,nns R �. � ..
Address: ' i�RF�'� ('.h��;tn��p F?; �', State Bond#: f� S
�::�!cope�:, ��iN ��.;.: ����/� �.,
City: ��? � 4�ip3 Expiration Date:
Phone'.� Alternate Phone:
❑ Insurance—Current:
, 1
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MEC�A1vICAL SYSTEMS BEING 1NSTALLED
Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS THIS GEOTHERMAL? ❑ Yes �No
HEATING SYSTEMS
Quantity: ��
Make: ��,1 1( r ,L '�
Model: ''��l I�-`�.�DS�'C' C �7-�(�'
Fuel:
Flue Size: �
lnput BTUs:
ouc�ut BTus: � G l� ��
CFM:
COOLING SYSTEMS
Quantity:
Ma1ce:
Model:
Tons:
H.Power
FIREPLACES .
Gas Factory Fireplace Brand Name:
Wood Buming Fireplace
Wood Stove , Model No.:
Wood Stove With Flue
VENTILATION
No. Kitchen Exhaust duct recirculating _cfm
No. Bath Exhaust(must have duct outside) _�frn
No. Other Fans: Locations __��
FUEL STORAGE {Must be apprmed by Fire Marshall if proposing to abandon tank in place.)
� Instailation � Removal
Fuel Oil: _gallons ❑ Undergound �Inside ❑Outside
LP Gas: gallons
Q.ther:
GAS,I.INE 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:
1. Does not require modification to electrical or gas service.
2. Has a total cost of$500.00 or less;excludine 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([f 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)
� ; !�G ��� .
(�'P `���C, �' X.o�2s $ �4 � <_-�',�
(contract price) (minimum$50.00)
2. STATE SURCHARGE ** Add the State Bldg Code Div. Surcharge(Minimum Fee of�5.00)
�', �U--
, i� �=����C� X.000s $ �- C�C�
�.l�
(contract price) (minimum$5.00)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
�
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � '. � ��
■ * CONTRACT PR[CE 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 of a signed copy of the actual contract.
■ **The STATE SURCHARGE is.0005 times the Contract Price or a minimum 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: �' ���L.u.� � Date: �r�� ' �
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