HomeMy WebLinkAbout2016-01151 - gas line only CITY OF ORONO * Z 0 1 6 - 0 1 1 5 1 *
� 2750 KELLEY PARKWAY
DATE ISSUED: 09/20/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 333 HOLLANDER RD
PIN : 25-118-23-43-0005
LEGAL DESC : REG. LAND SURVEY NO. 1281
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : GAS LINE ONLY
VALUATION : $ 3,500.00
NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL[NSPECTION.
ROUGH-IN THRU HOUSF,TO FUTURE POOL HEATER
APPLICANT MECHAN[CAL 50.00
STATE SURCHARGE MECH(VALUATION) 1.75
METRO GAS INSTALLERS TOTAL 51.75
685 141ST LANE NW Payment(s)
ANDOVER, MN 55304 CHECK 16286 51.75
(763)754-7119
Minnesota State License#: mech-MB003162
OWNER
TANNER,JOHN&DONNETTE
333 HOLLANDER RD
WAYZATA, MN 55391-
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 after 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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App cant Permitee Signature Date Issued Signature Date
' � ± FOR CITY USE ONLY
� ' � ���� City of Orono
P.O.Box 66 Date Received: Permit!t
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By: Amount$:
Phone(952)249-4600 Fa�c(952)249-4616
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�qk�5H0��.�' 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 RECENE 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 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 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.
TYPE OF PERMIT
(Check All That A ly)
�Residential ❑Commercial(Approval Required) [Backflow Device: ❑AVB ❑PVB]
❑ New �,Additional ❑ Repairs ❑ Replace
Job Site/Owner Information:
Site Address: � /�
/ �Owner: �,, '^-� ��' Mailing Address: � �
City: _�",ll'U � Zip:
Home Phone: (,(���` ,y7�(����� Alternate Phone:
Contractor Information:
/�� �� �.
Contractor: lX ����'" ' � Contact Person: /�� ����
Address: ��.5 ,�� " � I�V K,/State Bond #:
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City: � ,�� � Zip� Expiration Date:
Phone: ����' 1,j�J �1�� Alternate Phone: �����%�_����
❑ Insurance—Current:
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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:
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/Masonry
VENTILATION
❑ No. Kitchen Exhaust
❑ No. duct recirculating ��
Bath E�chaust(must have duct outside)
❑ No. Other Fans: Locations ��
cfin
FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place,)
❑ Installation ❑ Removal
FuelOil: gallons
LP Gas: ❑ Underground ❑ Inside ❑ Outside
gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill Other/List Wha �� �''�� "- "� ���� -`'�'
� t& Where:
2 � Gr� , . �G �
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PERMIT FEE CALCULATIONS
1. CONTRACT PRICE * is 1.25%of conttact price with a(Minimum Fee of$50.00)
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�`�`' x.0125$
(contract price) (minimum$50.00)
2. STATE SURCHARGE
x .0005 $
(contract price)
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
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.
MECHANICAL PERMIT APFLICATION 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 ap lication are complete,true and correct.
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Applicant's Signature: �J Date: � � /�(�
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