HomeMy WebLinkAbout2015-00381-voided t . •
F R C Y iJ�ONLY
�O A T City of Orono / Q'
<yO P.O.Box 66 Date Recei Permit#� U
2750 Kelley Parkway �i
Crystal Bay,MN 55323 Approved By: Amount$: 0 �,
Phone(952)249-4600 Fax(952)249-4616 I
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lqkfSH���� CITY OF ORONO-MECHANICAL PERMIT
(All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall)
GENERAL 1NFORMATION
by mail or in person at the City offices. Applications will
within two working days.
—� �S�'S e b�C�Z.C�TC' �►'i-- after a review is completed. PERMITS ARE NOT
:MIT. WORK MUST NOT BEGIN UNTIL T
S�S 7�-Yj'� E JOB SITE.
tions,details and specifications are required r eh
' ��Onl��l�r.Jr L"�� � �c�6 Yw� ?— lmidification,and air conditioning install on i luding
� r
mperatures,equipment ratings and ide icatio as to
/�Q�� ���-� 2 �ll be presented on form provided.
��� ng is involved,a separate buildin ermit mu be
/N0�v��0✓�-- vnf`� r"`'7
� D th the Uniform Mechanical de/St B dmg�jdde
d final). Call(952)24 � 600. ��
v
mitted before fin
� �
� �. � OFPER T
(Check All Th A 1
❑ Residential �Commercial(Approval quired)
❑ New ❑ Additional ❑ Repairs ❑ Replace
Job Site/Owner Information:
Site Address: �?0 �L �,,� �r��o # �� '
Owner: �otle�x o Mailing Address: (s0�;Tw�lv�z c��ts C�7Z qZ
city: �. a-t� zip: SS 3`� t
Home Phone: - �(?(�- op Alternate Phone: G l2- �3"1�- UI�.8
Contractor I rmation:
Contract : I�'�� �1�,,,�,�inq,�.k�n��► IA�1c. Contact Person: ('�ho.rl�L l,�)`, �So,r�
Addr s: L.�l45 YY�a�k{n�� C,f�-. State Bond#: ��c�p 3o\ltl
`� 'm���� Zip: YY�I� Expiration Date: �- �- l�.Q
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Phone: �(�e3-�l�t1- 229 u Alternate Phone: (y l2- 32�'- 7�Sd 5
❑ Insurance-Current: �,�.�cuPC z2o39q1
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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: 1 �
Make:
Model:
Fuel: �, �
Flue Size:
Input BTUs: �0 K
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity: ` � ,
Make: L-t.ly�_
Model:
Tons: Z.- 5
H. Power
FIREPLACES
❑ Gas Factory Fireplace Brand Name:
❑ Wood Burning Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Masonry
VENTILATION
❑ No. Kitchen Exhaust 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.)
❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside
LP Gas: gallons
Other:
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; excludinQ 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(If Applicable) $ �.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�U06 x .0125 $ 7SG `�
(contract price) (minimum$50.00)
2. STATE SURCHARGE
�!'J (�.'10 x .0005 $ 3� T
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 7$2• "—
I * 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 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.
A licant's Si nature: Date: 3` 3�� ��
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