HomeMy WebLinkAbout2016-01411 - gas line only �' CITY OF ORONO
, 2750 KELLEY PARKWAY * 2 0 1 6 - 0 1 4 1 1 *
DATE ISSUED: 1 U07/2016
' ORONO,MN 55356-
(952 249-4600 FAX: 952 249-4616
ADDRESS : 265 LEAF ST
PIN : OS-117-23-14-0002
LEGAL DESC : AUDITOR'S SUBD.NO.203
: LOT 009 BLOCK 000
PERMTT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : GAS LINE ONLY
VALUATION : $400.00
NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION.
REPLACE GAS LINE TO FUIRNACE APPROXATLY 30 FEET
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 0.20
CENTERPOINT ENERGY MAIL-IN FEE 2.00
6161 GOLDEN VALLEY RD TOTAL 52.20
BUILDING A
GOLDEN VALLEY,MN 55422- Payment(s)
(763)512-2765 CHECK 20654 52.20
Minnesota State License#:mech-MB003503
OWNER
STOCKTON,HARLAN
265 LEAF ST
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be perfom►ed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This perntit is for only the work described and dces
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.1'his permit may be
revoked at any time for due cause.
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Applicant Perm tee Signature Date Issued By Signature Date
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ty �E IV E D FOR CITY USE ONLY
• �O�O Ci of
P.O.Box 66 Date Received: Permit#
2750 Kelle P�� r��j a,y c
Crystal Bay�'�v�N 5532� ���u Approved By: Amount$:
Phone(952)249-4600 Fax(952)249-4616
y�, �' CITY OF ORONO
�•�KFSH04tc.C' CITY OF ORONO—MECHANICAL PERMIT
(All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall)
GENERAL 1NFORIVIATION
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 PERNIIT. 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 1
�Residential ❑Commercial(Approval Required) [Backflow Device: ❑AVB ❑PVB]
❑ New ❑Additional ❑Repairs ❑Replace
Job Site/Owner Information:
site Address: 265 Leaf St
o�er: Harlan Stockton Mailing Address: 265 L@af ST
cl�y: Orono, MN zip: 55356
Home Phone: 952-473-6762 Alternate Phone:
�
Contractor Information:
Contractor: CENTERPOINT ENERGY Contact Person: JOANN ZINKEN
AC1C�TeSS: 6161 GOLDEN VALLEY RD,BLDG A State BOriC�#: M6003503
C1Ty: GOLDEN VALLEY Zlp: MN Expiration Date: oai2oi2o�s
Phone: �s3-5�2-2�s5 Alternate Phone:
OLD REPUBLIC INSURANCE C0.
❑ WORKERS COMP&EMPLOYERS LIABILITY
I11SUr[lI1Ce—CUI�CeIlt: POLICY#WLRCC48597075
017
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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 BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H.Power
FIREPLACES
❑ Gas Factory Fireplace Brand Name:
❑ Wood Buming 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 cfin
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: rePlaCe gaS IIf12 t0 fUf f1aCe
approximatly 30feet.
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1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
400.00 X.o t 2s $ 50.00
(contract price) (minimum$50.00)
2. STATE SURCHARGE
400.00 X.000s $ •20
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 52.2�
■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
pertnitted 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.
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: 10/28/2016
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