HomeMy WebLinkAbout2010-00128 - gas line only * f
CITY OF ORONO PERMIT NO.: 2010-00128
2750 KELLEY PARKWAY
ORONO, MN 553�6- DATE IssUEu: 03/08/2010
952 249-4C00 FAX: 9�2 249-4616
ADDRESS : 4149 HIGHWOOD RD
PIN : 07-]17-23-44-0018
LEGAL DESC : HIGHWOOD LAKE MTKA
: LOT 022 BLOCK 000
PERMIT TYPE : MECHANICAL(<$500) �
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHl�Dd�tAL- MJ�L�I`IPLE ,,<�'Jt�� 4—�, a'� �,�L:�
�
NOTE: GASLINE FOR COOKTOP AND MOVE DRYER-ALSO OUTDOOR GRILL
APPLICANT
MECHANICAL(<$500) 15.00
ABOVE& BEYOND PLUMBING INC
6431 153RD LANE NW STATE SURCHARGE MECH (<$500) 0.50
RAMSEY, MN 55303- TOTAL 15.50
(763)360-6568
Minnesota State License#: 70645526
OWNER
KOCH, MARK&NANCY
4149 HIGHWOOD RD
MOUND, MN 55364
AGREEMENT AND SWORIY STATEMENT
The work for which this permit is issued shall be perfonned according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additio��al or related work which requires separate
permits. All provisions of laws and ordinances eoverninc tliis type of work
shall be compied with whedier or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of]80 da_ys at any time after work has commenced.
The applicant is responsible for assuring all required inspections arc
requested in conformance with the State Quilding Code.This pennit may bc
�revoked� any time for due cause.
--___.._ / / `�
Applicant Pennitee Signature Date � v � � ��
Iss B��Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
! "� a �'*'
FpR CITY USE ONLY �
O,¢p�,O City of Orono ��� �
P.O.Box 66 Date Received: ' Permit#�_
2750 Kelley Parkway
� ,�. .,,.� Crystal Bay,MN 55323 'Approved By: Amount$: ���
(952)249-4600
�asxo8y
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. 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 Desiens—Complete calculations,details and specifications are required for each
heating,ventilation,humidification-dehumidification,and air conditioning installarion 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 pernut must be
obtained.
5. All work must be done in accordance with the Uniform Mechanical Code/State Building Code
requirements.
6. All 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.
T'YPE OF PERMTT
�heck A11 That A 1 )
esidenrial ❑ Commercial(Approval Required)
❑ New ❑Addirional ❑Repairs ❑ Replace
Job Site/Owner Information:
Site Address: yly9 ��A��
Owner: �vk,,�c �. ,J�,,w��,�.1,� Mailing Address:
City: f��,,,o Zip:
Home Phone: Alternate Phone:
Contractor Infoxrnation:
Contractor: �,� �.�,,.fl,,,n Qlu,�'� Contact Person: � ��„
Address: Coy31 tS.�''�Lti �LJ State Bond#: � �p(os'�38�
City: Zip:5�'303 Expiration Date: � —3�--Z o//
Phone: �3 -3t� rc.st.�� Alternate Phone:
❑ Insurance—Current:
1
ra � �, �
Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS THIS GEOTHERMAL? ❑ Yes ❑ No
HEATING SYSTEMS
Quantity:
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H.Power
FIREPLACES
❑ Gas Factory Fireplace Brand Name:
❑ Wood Burning Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove With Flue
VENTILATION
❑ No. Kitchen Exhaust duct recirculating cfin
❑ No. Bath Exhaust(must have duct outside) cfm
❑ No. Other Fans: Locations ��
FUEL STORAGE (Must be approved by Fire Marshall iJproposing to abandon tank in place.)
❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑ Inside ❑Outside
LP Gas: gallons
Other:
GAS LINE ONLY
.LT/ Outdoor Grill ❑ Other/List What&Where: (��i� �c ('c��C '�D
l
2 �'�'re �r�.�' „
. � : a
.���
❑ Yes,this secrion applies
The replacement of a Residential fixture or appliance that meets all three of the following requuements:
1. Does not require modificarion to electrical or gas service.
2. Has a total cost of$500.00 or less;excludins 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 Pernut $ 15.00
State Surcharge $ .50
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $
If above does not apply;follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
2C7iC�°%� x.0125$ �?v
(contract price) (minimum$50.00)
2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50)
x.0005 $ �SU
(contract price) (minimum$ .50)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��'
■ * 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 installarions 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 pernut 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 of the Building Department at(952)249-4600 for the price.
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: ����/v
3