HomeMy WebLinkAbout2011-00434 - gas fireplace � CITY OF ORONO PERMTT NO.: 2011-00434
,
� 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE IssuEn: 06/0'7/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 155 KINTYRE LA
PIN : 32-118-23-43-0016
LEGAL DESC : KINTYRE TWO
: LOT 2 BLOCK 1
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIREPLACE-GAS
VALUATION : $ 2,400.00
NOTE: 1 HEAT N GLO PALOMA-GY
APPLICANT MECHANICAL 50.00
GLOWING HEARTH AND HOME STATE SURCHARGE MECH(VALUATION) 1.20
100 ELDORADO DRIVE
JORDAN,MN 55352 MAIL-IN FEE 2.00
(952)495-2927 TOTAL 53.20
OWNER
ROLL&JACQUELINE WILLIAMS-ROLL,MICHAEL
75 FERNDALE RD N
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 c�ue cause.
�w'� �� � � / /
Applicant Permitee Signature Date Issued By Si re ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO
� �uR crrx us�or�.x
a,���,4 City of Orono '
P.O.Box 66 Dat�'l�eceivect: Pe[sni�#
2750 Kelley Parkway \
��� Crystal Bay,MN 55323 �#ppz�tuedHy: A�t$;
Phone(952)249-4600 Fax(952)249-4616 i
CITY OF ORONO-MECHANICAL PERMIT
(All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall)
�T�'��.+�F��f�����..., a,
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 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.
� ������� �: "� ��
��lt*��:�.��Tr"� � .,�
�Residential ❑Commercial(Approval Required)
�New ❑Additional ❑Repairs ❑Replace
�U��It�/.�WT�+E�"��1��1���J1I:: �.,, ; ',:
Site Address: I 5� � 1 �}�
Owner:��1��.P �t,�n�- � ���rS MailingAddress: f��a���i►n.Q�/���e�
ciry: ��n�r/lc.v� zip: 5s�9 /
Home Phone: Alternate Phone: �s�'47� �,�y�S�'
et�ntraet��.�ft�rm:�it��
Contractor: ' G , ` /�j�ContactPerson: �,��uS
Address: � � 1� State Bond#: I
City: JC)►raU..�l Zip��S�Expiration Date: � 1-
Phone: �,��fCj�- '�f�-7� Alternate Phone:
Insurance-Current: �b � I D �-- � ' �-//1
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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 BTiJs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H.Power
FIREPLACES
� Gas Factory Fireplace Brand Name: �
❑ Wood Burning Fireplace �
❑ Wood Stove Model No.: � j91 �'� ,
❑ Wood Stove with Flue/Masonry
VENTILATION
❑ No. Kitchen E�chaust duct recirculating cfin
❑ No. Bath Exhaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfrn
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:
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❑ Yes,this section applies
The replacement of a Residential fitcture 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;excludine 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) $ 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$50.00)
��-vo, u� X.0�25$ 50-�v
(contract price) (minimum 550.00)
2. STATE SURCHARGE � `�
��U� � UU x.0005 $ / `�v
(contract price)
3. POSTAGE&HANDLING(Only on Mait-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $���� v
■ * 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 ainount to be chazged
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 mazket 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.
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: �-I � L�
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