HomeMy WebLinkAbout2005-P08902 - gas lin to new furnance for LL finish PERMIT
CITY -JF ORONO
27�0 Kelley Parkway- PO Box 66 Permit Number: P08902
Crystal Bay, Minnesota 55323 Permit Type:
Mechanical Pernuts
(952) 249-4600 Date Issued: 7/1/2005
SITE ADDRESS: 565 Leaf Street Unit#
Long Lake,MN 55356
PI D: OS-117-23-41-0028
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Mechanical Permits Permit Sub-type(s): Multiple Mechanical Items
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Gas line to new furnace for LL finish
FEE SUMMARY: Pernut Fee: $ 75.00 Valuation: $ 6,000.00
State Surcharge Fee: $ 3.00
TOTAL FEE: $ 78.00
APPLICANT: Kalmes Mechanical Inc. OWNER: Kosierazki&Fox
15440 Silverod St Nw 565 Leaf Street
Andover,MN 55304 Long Lake MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNAT ISSUED BY SIGNATURE
Copies: 1-File(SignaturesReguired), 1-Applicant, 1-MonthlyReports, 1-Assessing,(IfSeptic, 1-Septic) Page l
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� FOR CITY USE ONLY
� � City of Orono / ^� ,�8
O� �O P•O.Box 66 Date Received: (p'�'U�Permit# ��
- �,�,,,,,a 2750 Kelley Parkway �
}j'�.'�;r''�_ � Crystal[3ay,MN 55323 Approved By: Amount$:
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� �(�� �.a (952)249-4600
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CITY OF ORONO—MECHANICAL PERMIT
(All Commercial pennits must Ue approved by the Building Ofticial or Inspector and/or Fire Marshall)
GENER.AL INFORMATION
1. You may apply for mechanical pernuts by mail or in person at the City offices. Applications will
be reviewed and a permit will be issued within two working days.
2. Pernut cards will be sent by return mail after a review is completed. PERMITS ARE NOT
VALID U�1TIL YOU RECEIVE A PERMIT. WORK�TUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical Desi�ns—Complete 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,manufactw•er and model. Data shall be presented on foim provided.
4. �Viren any new construction or remodeling is involved, a separate building pernut 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(9�2)249-4600.
(24-48 hour notice required)
7. House Heating Test Record must be subnutted before final.
TYPE OF PERMIT
(Check All That A ly)
Residential ❑ Comrnercial(Approval Required) [���� �S� ���,Cl.P.vv.Q,�,�1f � 'iv�.w��!
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❑ New ❑ Additional ❑Repairs ❑Replace
Job Site/ Owner Information:
Site Address: �J�O � �Efq� `J"�
Owner: Mailing Address:
City: a ��t7 Zipk Cj�3 5�O�
Home Phone: Alternate Phone:
Contractor Inforn�ation:
Contractor: �'V�t�ME S ��.C,�u�,Z�ntact Person: 1 1 Vv� M� �U.�,�'IM�,,,�,�
Address: ���'n � �I V-¢I�� Sr �F/�1te Bond #:
City: ���'OV� Zip:��0`�xpiration Date:
�,(�Ll. Phone: ��0 3 3�o �o'.�,�j ( Alternate Phone: q 5� �� 3 ��37
❑ Insurance— Current:
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MECHANICAL SYSTEMS BEING 1NSTALLED �
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HEATING SYSTEMS
Quantity: �
Make: ��tuNOX'
'g'�; Model: �S I M(� O��rI�"��s
�°�� Fuel: �Q.1� 4�l.t/1
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Flue Size:
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Input BTUs: �+-J��'�4�
��.�� Output BTUs: �-�� 00�
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CFM: ��b
� ' COOLING SYSTEMS
�,:;
�� Quantity: '
�•
�' Make: L�JN��
"'�; Model: �`�7���'O 1 a
Tons: � `��
; ,;' H.Power � ��1 _
FIREPLACES �O �I�S t:����12.�� ��
❑ Gas Factory Fireplace
❑ Wood Buniing Fireplace
❑ Wood Stove
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❑ Wood Stove Witli Flue
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"�`'` Brand Name: Model No.:
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VENTILATION �,��S'��
�'", ❑ No. Kitcheil Exhaust duct recii•culating cfm
❑ No. Bath Exhaust(inust have duct outside) cfm
❑ No. Other Fans: Locations cfm
FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHALL) ^JO�I�
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❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑ Inside ❑ Outside
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„ LP Gas: gallons
� Other:
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�s: GAS LINE OtiLY
.
fi�� ❑ Outdoor Grill ❑ Other/List What&Where: ( O �'E�) �V v�Cc(�_ `�CU�
a:�
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_ PERMIT FEE CALCULATION(S) ;;
BASED OFF - 2002 STATE STATUE
❑ Yes,this section applies
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The replacement of a Residential fixture or appliance that meets all tluee of the following requirements:
1. Does not require modification to elecri�ical or gas service.
2. Has a total cost of$500.00 or less;excludin�the cost of the fixture or appliance: and
3. Is improved, installed or replaced by the homeowner or licensed contractor. ``
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Skip next section, if this applies; Cost of Pernut $ 15.00
State Surcharge $ .50
Mail-In Fee(If Applicable) $ 1.50
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 conn�act price with a(Minimum Fee of$35.00)
��PDCJO �u x.0125 $
(c tract price) (minimum 535.00) '�
2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50)
�b
x.0005 $ Y'
(contract price) (minimum$ .50)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
■ * 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 aniount 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 marlcet value of such items must be added to the
estimated cost or contract price for pernut 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. 'r
■ ** The STATE SURCHARGE is .0005 of the Building Department at(952)249-4600 for the price. <;<
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.
_. � �3`'�0 '�
Aprlicant's Signature: �^"�� Date:
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