HomeMy WebLinkAbout2015-00903 - mechanical J " � CITY OF ORONO
2750 KELLEY PARKWAY * 2 0 1 5 0 0 9 0 3 *
DATE ISSU D: 07/20/2015
ORONO,MN 55356-
. 952 249-4600 FAX: 952 249-4616
ADDRESS : 2670 KELLEY PKWY 210
PIN ' : 33-118-23-12-0058
LEGAL DESC : STONEBAY OF ORONO CONDOMINIUM
I : LOT 000 BLOCK 000
PERMIT TYPE ' : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYP� : HEATING SYSTEMS
VALUATION � : $ 2,786.00
NOTE: (1)LENNOX HEA G SYSTEM-66,000 INPUT BT[J'S-62,000 OUTPUT BTU'S
AP LICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 1.40
MARSH HEATING&AIR COND MAIL-IN FEE 2.00
6248 LAKELAND AVE N
MINNEAPOLIS,MN 554 8- TOTAL 53.40
(763)536-0667 Payment(s)
Minnesota State License# mech-MB003532 CHECK 85976 53.40
�WNER
LAGUE,JEROME&JOY
2670 KELLEY PKWY 21�
LJNIT#210
LONG LAKE,MN 55356,
AGREEMENT AND SWORN STATEMENT
The work for which this permit s issued shall be performed according to
the approved plans and specific tions,applicable City approvals,and the
State Building Code. This pe it is for only the work described and dces
not grant permission for additio al or related work which requires separate
permits. All provisions of laws d ordinances goveming this type of work
shall be compied with whether r not specified herein.This permit will
expire and become null and voi 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' suring all required inspections are
requested in conformance with e State Building Code.1'his permit may be
revoked at any time for due cau e.
. � i.Zl>� /.S
Applicant Permitee Signature Date Issued Signature ate
G ' ,
FOR CITY USE ONLY
�O^ T � City of Orono �� '" D
r yO � P.O.Box 66 Date Received: Permit# CE v
2750 Kelley Parkway
� '1 Crystal Bay,MN 5�323 Approved By: _ Amount$:
� Phone(952)249-4600 Fax(9�2)249-4616 �� ,5
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�.�k�s�o.��,�' CITY OF ORONO—MECHANICAL PERNl4`rTYOFORONO
(All Commercia]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 retum mail after a review is completed. PERNIITS ARE NOT
VALID UNTII,YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN Ul\'TIL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical Desiens—Compiete calculations,details and specifications are required for eacl�
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 pi•ovided.
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 Mechanica] 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� 1 )
,�Residential ❑ Commercial(Approval Required)
❑ New ❑Additional ❑Repairs �Replace
Job Site/Owner Information:
Site Address: � ���J /�t'.L�t'_� ¢�/-��'� ��/ �
r �
Owner: JC7`I L c��C���� Mailing Address: ��iYl� �
city: C�rc�6�C> �'�- �'
z�p: ����_ ��t � ,
Home Phone: Alternate Phone:
;
Contractor Information:
Contractor: /'I PCjTl17 ��G Contact Person: /�efl �IGI/'S
Address: ��/S�A�2/A/2��1/e.JV State Bond #: m� �D�S?
City: �vf'001�1 I�/�r� ��/Zip:55�{cZg Expiration Date: 8
Phone: 7�0������� Alternate Phone:
❑ Insurance—Current:
1
, ' �
MECHANICAL SYSTEMS BE1NG 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: ��'N/V J X
Modei: ��J�1,3L!�d7i��'�3(�
Fuel:
Flue Size:
Input BTUs: �OIO,C�i�i
Output BTUs: �^2..���1
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 E�aust duct recirculating cfm
❑ No. Bath Exhaust(must have duct outside) cfin
❑ No. Other Fans: Locations cfm
FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.)
� ; • , ' ' �, , •�� 'c���� �,`7-,+ �
- '� �' Instaliation ❑ Removal ' ` , '' • � ' `
. •
,���'�~ � . �Fuel Oil.r `�. gallons Q,,L�n}iezgrb�d��[�nsi�e'��]�Outside
. LP Gas: gallons
, r,:� ,9thaz�� :�►'.a s; '+!�,' -: „`•,'�,t��.;: `;''.
, . . , .. - � � .� ,. � .� 1'.-.
GAS LINE ONLY � , ;� .._� �
, � ,�, ,
❑ Outdoor Grill ❑ Other/List What&Where:
2
�.
� ,
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;excluding 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 $ 15.0
State Surcharge $ 1.00
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)
o`��(�U. — x .0125 $ JL'���,
(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) $ �3,"`�C�
■ * CONTRACT PWCE or JOB COST means the actual or estimated dollar amount charged for the
permitted wark 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 ot the job cost, the City may request the submission of a signed copy of the actual contract.
ME�HANI�AL PERIVIIT 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.
Applieant's Signature: ��� Date: '"T�l��l.�
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Client#: 13152 MARHE
ACORDTM i CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYV)
03/20/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY HE POLICIES
BELOW.THIS CERTIFICA�E OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), UTHORIZED
REPRESENTATIVE OR PF{ODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certiflqate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS W VED,subJect to
the terms and conditions bf the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu o such endorsement(s).
aRo�uceR Bonnie Huber
NAME:
J.A. Price Agency,Inc. I PHONE 952 944-8790 952 944-0097
6640 Shady Oak Road �A Lo �c: ac o:
nonRess: bonnie.huber@japrice.com
SUIt@ SOO INSURER S AFFORDING COVERAGE NAIC#
Eden Prairie, MN 55344-6176 The Cincinnati Insurance Co 10677
INSURER A:
�NsuReo iNsuReR s:Accident Fund Insurance Co of 10166
Marsh Heating�&Air Conditioning Co Inc
6248 Lakeland�venue North INSURER C:
Minneapolis,M 55428 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISIQN NUMBER:
THIS IS TO CERTIFY THAT �HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR HE POLICY PERIOD
INDICATED. NOTWITHSTAND NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPE T TO WHICH THIS
CERTIFICATE MAY BE ISSU�D OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT T ALL TNE TERMS,
EXCLUSIONS AND CONDITIO S OF SUCH POIICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TypE OF INSURAN E ADOL SUBR POLICY EFF POLICY EXP �� RS �
LTR IN POLICY NUMBER MM/DD MM/DD
A GENERALLIABIUTY I EPP0134310 4/01/2015 04/01/201 EACHOCCURRENCE s1 000000
X COMMERCIAL GENERAL L'ABIUTY ��EM�C�F�T�tENTED
I 3 a occurrence S 500 000
CLAIMS-MADE �I OCCUR MED EXP(Any one erson) $�O OOO ,
� PERSONAL 8 ADV INJURY $� OOO OOO
GENERALAGGREGATE 32 OOO OOO
GEN'L AGGREGATE LIMIT APPL ES PER: PRODUCTS-COMP/OP A $2 OOO OOO
POLICY X PRa LOC $
A AUTOMOBILE LIABILITY EBA0134310 4/01/2015 04/01/201 COMBINED SINGLE LIMIT
Ea accident �r�0�r��0
X ANY AUTO BODILY INJURY(Per perso $
ALIOWNED SCIiEDULED BODILYINJURY(PeracGde t) $
AUTOS AUTOS
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS Per accident
a
q X UMBRELLALIAB X occua EPP0134310 4/01/2015 04/01/201 EACHOCCURRENCE a3000000
EXCESS LIAB CLAIMS-MADE AGGREGATE $3 OOO OOO
DED X RETENTION$ $
B WORKERSCOMPENSATION �. WCV6OZ9S�G 4/07/2015 04/01/201 X WCSTATU- 0 -
AND EMPLOYER$'LIABILITY
ANY PROPRIETOR/PARTNER/EX�CUTIVE Y�N E.L.EACH ACCIDENT SrJOO OOO
OFFICER/MEMBER EXCLUDED9 � N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOV E $5����0
If yes,describe under
DESCRIPTION OF OPEfL1TIONS alow E.L.DI3EASE-POLICY LIMI $rJOO��}�
DESCRIPTION OF OPERATIONS I LOC TIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
CERTIFICATE HOLDER CANCELLATION
Clt Of OPOIlO SHOUID ANY OF THE ABOVE DESCRIBED POLICIES BE ANCELLED BEFORE
y THE EXPIRATION DATE THEREOF, NOTICE WILL E DELIVERED IN
P.O.BOX 6B ACCORDANCE WITH THE POLICY PROVISIONS.
Crystal Bay, M�J 55323
AUTHORIZED REPRESENTATIVE
O 1988-2010 ACORD CORPORATION. II rights reserved.
ACORD 25(2010/05) 1 qf 1 The ACORD name and logo are registered marks of ACORD
#S154592/M154529 I BLH
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