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CITY OF ORONQ� � �ERMIT TYPE: �,���.rj��,�?�.��
1335 Brown Rd. South • P.0 ��.;� :��, � Permit Number: i:it:�:�7�_�
Crystal Bay, Minnesota 55323 Date Issued: t'=r�r'i�=,/'�i
(612) 473-7357
SITE ADDRESS:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE JQ�-�
� CITY OF
r ;� ORONO ` �
� �- L�L� .C�'`�0�"r� �
CITY OF ORONO -
APPLICATION FOR MECHANICAL PERMIT �����
GF.NF.R AT. INFORMATI ON
1. You may apply for mechanical permits by mail or in per�il� a� �h�„C�ity
offices. Mailed-in permits are subject to the postage and handling fees
shown below.
2. Permit cards will be sent by return mail the same day the application is
received. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT
BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE.
3. When any new construction or remodeling is involved, a separate building
permit must be obtained.
4. All work must be done in accordance with State Building Code requirements.
5. A1 1 work must be inspected (rough-in and final). Cal 1 473-7357. 24-hour
notice required.
6. House Heating Test Record must be submitted before finaZ.
INSTRIICTIONS Complete ail items on this application. Compute the permit fee.
Sign and date the certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
If you have questions, call 473-7357.
WALK-IN PERMITS apply at City Offices, 1335 South Brown Road (Cty. Rd 146)
MAIL-IN PERMITS enclose fee - Mail to: P.O. Box 66, Crystal Bay, MN 55323
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Please check one: New Addition Repair �Replace
JOB SITE: � j���-� i,�c%;�_,,1 %���- Zip:
Owner' s Name: ( ,�� � I F-=�� �f�c:r�(l� 4��` Telephone Number:
--,
;�ailing Address: `� , `,� � � '-c,� ' City: Zip:
Contractor' s Name: Telephone Number:
Mailing Address CTI(1WSP6RK6�55d�6 City: Zip:
*********************���2�el��IV10!'�14********************************************
MINIMUM FEE ($30. 00 per project) �
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SYSTEM DESCRIPTION: $15. 00 each unit
Heating Systems:.
Q�aar.tit j: '�
Make: L_-����1��, �� --
Model: ��:_. ��� �' �
Fuel: - �
Flue Size:
Input BTUs . �'��'1'1
Output BTUs
CFM:
********************************************************************************
Cooling Systems•
Quantity: •�
� Make: [_���"�l�''��/
Model: I `�/,ti � � '
Tons: �
H.Power:
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*WOOD BIIRNING EQIIIPMENT $15. 00 each unit
Wood stove with flue
Wood combination or add-on unit
Factory fireFlace with flue
Factor Fireplace (s ) freestanding Masonry
Wood Stove (s ) franklin, other
BrandName Model No.
Mfgr' s Min. � Clearances, side , rear , min. flue dia.
Total
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VENTI7�ATION $15.00 each project
*io, Kitchen Exhaust ducted recirculating cfm
No. Bath Exhaust (must be duct�d ou�side) � cf�
No. Other Fans: Locations cfm
Total
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FIIEL STORAGE (must be approved by fire marshal)
' $30. 00 Permanent/Temporary
Fuel oil, gallons underground inside outside
LP Gas, gallons
Other Gas opening
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GAS LINE INSPECTION
High/Low Pressure $15 . 00
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PSRMIT FEE CALCIILATION
1. Total of above Installations or Minimum Fee ($30.00) $ ""���
2. State Surcharge. Add the State Building Code Division
Surcharge to each permit $ . 50
3. Postaqe and Handling on all mailed-in agplications, S 1.50
4. TOTAL PERMIT FEE add lines 1-3 above $ =;:� :, �
The undersigned hereby applies to the City of issuance of a Mechanical Permit,
agree5 i.0 c►o aIl wc�rk in s�r�ct accordance with the ordinances of the City and
the regulations of the Minnesota State Building Code, and certifies that all
statements made on this application are comglete, true and correct.
. ,
� � _�;�
Agplicant' s Signature: ''� ' - ����G,"' ' Date: � �� � �
/ �/v'i
� � � I HOUSE HEATING TEST RECORD �VN�'—C �' �?6�
ADDRESS �-- � � � I'�, t-�.l.�I_��� t�i APT. FLOOR CITY SUBURB ��-� ��
OCCUPANT / OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY �l�C�1 �-,��� N C�
Electrical Work By Gas Line By
TYPE OF HEAT GA FA�HW STEAM SPACE HTR. _UNIT HTR. OTHER
GAS DESIGN CONV N �
MAKE L���rs ox MAKE OF BURNER
Model � �<Q-�-� Model
Serial ��Q�' _� Max. BTU Rating
INPUT �� � �.7�
MAKE OF FURNACE _ �
Model
� CONTROLS �� -��g� 2 '1 '�Q`
THERMOSTAT� Heat Plug Vent Size �`�,
Valve ��I i'`i � ��J>> KIND OF LINER $IZE NONE �
Limit �,1�Tt7 � � � Droft Hood � M Regulator ���
Limit $etting e Filters Size �d t �
�� � Number
Fan Setting Chimney Location �jside x Outside
Pilot Type � Chimney Consfruction / �/ L-f---�Y`����?
Pilot Make
Pilot Model $moke Bomb � Wiring �
Pilot Timing Draft �/ K Test Tay �
L.W. Cut Off Door Pressure Lightiny Inst.�
�p s� �. �(�_ � �6 �.'� !
Prossure � � Cl Percent COZ�X � Date Tested
Irrpuf CFH �• ��' Percent 02 `,� Company Testing � � �T 1 �`f �� ��
Stack Temp. ' � � Perce�t CO a Q Name oi Tester �T � /� �-
Form 235