HomeMy WebLinkAbout2014-00566 - gas fireplace r �
CITY OF ORONO * Z 0 1 4 - 0 0 5 6 6 *
2750 KELLEY PARKWAY DATE ISSUED: 06/09/2014
ORONO, MN 55356-
952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1135 LOMA LINDA AVE
PIN : 08-117-23-23-0019
LEGAL DESC : LOMA LINDA
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIREPLACE-GAS
VALUATION : $ 2,000.00
NOTE: KOZY HEAT GAS FACTORY FIREPLACE
APPLICANT MECHANICAL 50.00
PRACTICAL SYSTEMS STATE SURCHARGE MECH(VALUATION) 1.00
4342B SHADY OAK RD MAIL-IN FEE 2.00
HOPKINS,MN 55343 TOTAL 53.00
(952)933-1868 Payment(s)
CREDIT CARD 0961 53.00
OWNER
THURLO,MR.&MRS.MARK
1135 LOMA LINDA AVE
MOUND,MN 55364
AGREEMENT AND SWORN STATEMEIVT
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 sepazate
permits. All provisions of laws and ordinances goveming 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 pe it may be
revoked at any time for due cause.
i (o � /
Applicant Permitee Signat re Date Issue y Signature Date
�529331 Q69 17:57:04 06-05-2014 2/4
OR CI 1'liS� NLY �
�O A' City of Orono �/��(� �5
�yO P.O.I3ox 66 Dmo Re•ei� d:� / ermit f�C:� �
2750 Kclley Parkway
Crystal Bay,MN 55+?3 Appro��cd By: Amount S:!_
Phone(9S2)249-4G00 Fa.+c(952)249-A616
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�.oKFst+o��.� CITY OF ORONO—MECHANICAL PERMIT
(All Commercial pertuits must be npproved by the Building Official or Ins�x:ctor and,�or l�ire Marshail)
GENERAL INFORMATION
l. You muy�ppty for meclianical pennits by mnil or in person at the City oftices. Applications will
be reviewed and a perniit will Ue issued�vithin rivo�vorking days.
2. Pennit carcis�vitl be sent by reh�rn mail�fter a revie�v is con�plcted. P�RMITS AI2�NOT
VALID UNTIL YOU RECENE A PERM[T. W012K MUST NOT BEGLN UNTIL TNE
PERMTT CARD IS POSTED ON THE JOB SITE.
3. Mecl�anicai Desiens—Complete calculations,details and specific�tions are required tor each
heuting,ventilntion,humidification-dehumidificntion,and nir conditioning installation including
heat loss/heat gain calculation,design temper�tures,equipment ratin�s and identi6cation as to
type,mnnufacturer and mode{. Dnta shall Ue presented on fonn provided.
4. Wlien�ny new construction or remodelin�is involved,a se��arate buildin�pennit must Uc
obtained.
5. All work must Ue donc in accordance�vith the Unifonn Mechanical Code/SEate Building Code
requiretnents.
G. All�vork niust Ue inspected(rough-in and tinal). Call(952)249-46U0.
(24-48 haur noticc rcquired)
7. l�ouse He�►ting Test Record must be submitted before final.
TYPE OF PERMIT'
Check All That A 1 )
�Residential ❑Commercial(Approval Required)
[�New ❑Addiiional ❑Repairs ❑Rcplaee
Job Site/Owner Informalion:
Site Address: I l 3 S C..e��,�it. ��n c�� r�ht�.-
Owner:�e-�s�y/4�'�,u�-�'1���r� G Mailing Address: l l �"`� �..o��'+� ��%+��? ./���
�
Cl�y: ��C'%Lt�.� Zlp: J J ✓��l'
Home Phone: r��;��Z/7;� -���17 � Alternate Phone:
Contractor Information:
Conlracror: Prtaertca�sYsrEMs ContactPerson: `t� 2:�'Cf� 1-1c:� v>jC.�1c.L
43426 SHADY OAK RD
HOPKINS,MN 55343
Address: State Bond#: \�F;��0 3`.-r C'U
City: Zip: Expirntion Date: `� 1 I '� � !�/
Phone: GI���-`���-�" �`D ir.�`� Alternale Phone:
❑ Insurance—Current: �.c,(��:..�� ���o��
1
,9529331�69 17:57:21 06-05-2014 3/4
.
1VIECHANTCAL SYSTEMS BEING:TNSTALLED
Note:All Geothermal Systems will now require a Site Plan&Revie��v by our Building Official.
IS THIS GEOTHERMAL? ❑Yes Q'�10
HEATING SYSTEMS
Qt�lntity: \ l I
Make: f�o Zc. �(',a�
Model: -� �c�, m���� iSC.�C)
Puel: �� �:�5
Flue Size:
�
Input B1Us: I),I��00
Output BTUs: 1
Cf M:
COOLING SYSTEMS
Quantity:
Make:
Model:
'I'ons:
H.Power
FIREPLACES
/
� Gas Fa�tory Fireplace f3rand Name: I{n 1�J ' �"`��
❑ Wood Bumine Pireplace
❑ Wood Stove Model No.: J�ic-��";r.%n ���,��• ��rj C�
❑ Wood Stove witl�Clue/Masonry
VENTILATION
❑ Na Kitcl�en Exhaust duct recirculating ctin
� No. B�th�xh�ust(must t�ave duct outside) ctin
No. Otl�er Pans: Locations cfm
FUEL STORAGE (Miis!be npprored Gy Fire Mnrshal[if proposrng to nbandon tnnk in pince.)
❑ Inst�llation ❑ Ren�oval
I'vel Oil: gallons ❑ Underground ❑Inside ❑Outside
LP Gns: gallons
Otl�er:
GAS LINE ONLY
❑ Uutdoor Grill ❑ Uth�r/List What&Whcre:
2
9529331869 17-57:32 06-05-2014 4/4
' PERMIT EEE CALCULATION(S)
` BASED OFF-2002 STATE STATUE
❑ Ycs,tl�is section applies
The replacement of a Residential lixture or appliance that meets all tlu'ee of tl�e following requirements:
1. Does not require moditication to electric�l or gas service.
2. I�as a total cost of$500.00 or less;excludina the cost of the fixn�re or appliance:and
3. Is impruved,installed or replaced by the liomeowner or licensed contractor.
Skip next section,if this appties; Cost of Perniit � t 5.00
State Surcharge � 5.00
Mai]-In Fee(If Applicable) $ 2.00
TotuE Permet Fee $
PERMIT FEE"CALCULATION S —JOBS`OVER'�500:00
If above does noE app(y;follow guideli�ies belo�v_
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$SQ.OU)
�� 5 a
�,�OCC� ..ol2s�
(contract pricc) (minimum 550.00)
2. STATE SURCHARGE ,,n
;.�f�C°�,i x.0005 � I, �U
(contract pricc)
3. POSTAGE&HANDLING(Oniy on Mnil-In Applications) $ 2.00
�;� uU
4. TOTAL PERMIT FEE(Add Lines i-3 Above) $
■ * CON"T'I2ACT PRICE or JOB COST means tiie �ctual or es�imated dollar amount charged f'or the
permitted work incittding materials,11bor,profit,and other tixed cosis. It is U�e amount to bc cliargect
to Uie customer for tlte work done. If any material,equipment, labor or inst�llations are hirnished by
the awmer, tenant or any otlier party, tlae re�sonable mnrket value of such items must be added to the
estimated cost or cotttracl price for peimit fee purposes. In the event tl�at there is a dispute on the
amoimt of the job cost, the City m1y rec�uest the submission of a siened copy of tlie actual contract.
Iv1ECHANTCAL PERIVIIT APPLICATION AGREEMENT ,
The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do aii
work in strict accordance with che ordinances of die City and the regulations of the State of
Minnesotu, and certifies that all staiements made on this application are complete, true and
concct.
A licant's Si natur � `J�ti u �� -tiv:)�.--�L��--- f�? �-, �
pP g �_ -T C � � ��Gt, Date:
3