HomeMy WebLinkAbout2014-01344-EXPIRED , -� CITY OF ORONO * Z 0 1 4 - 0 1 3 4 4 *
2750 KELLEY PARKWAY DATE ISSUED: 1 U17/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2660 LYDIARD AVE
PIN : 21-117-23-23-0031
LEGAL DESC : VERN-MAR MANOR
: LOT 005 BLOCK 000
P�RMIT TYPE : MECHANICAL(> $500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIREPLACE-GAS I � , /
VALUATION : $ 1,800.00 � �C�� � � V � V �
NOTE: KO"Z_Y HGA"C JACKSON �IR�PLACE �(�' � � , �
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APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH (VALUATION) 0.90
RIVER CITY SHEET METAL INC. MAIL-IN FEE 2.00
8290 MAIN ST. NE TOTAL 52.90
SUITE 39
FRIDLEY, MN 55432 Payment(s)
(612)754-2199 CHECK 10975 52.90
Minnesota State License#: mech-003364
OWNER
BAUER, MR. & MRS.
2660 LYDIARD AVE
EXCELSIOR, MN 55331-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall bc performed according to
the approved plans and specitications,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
pennits. All provisions of la�vs and ordinances governing this type of work
shall be compied with whether or not specitied herein.This permit will
expire and become null and void if eonstruction authorized is not
commenced within 180 days ot�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 tbr due cause.
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Applican ermi ee Signature D• e [ssue �y Signature Date
��1 CITY SE ONLY
��� City of Orono _ '`.�_:`...'_ o�� f�
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�� P.O.Box 66 Date Received: ermit#
�t 2750 Kelley Parkway G,
i ti� Crystal Bay,MN 55323 �Y�Ov � '�!7 Approved By: Amount$��� �
Phone(952)249-4600 Fax(952)249-d616
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��.�K��t����"� CIT�"�O�"OKONO—MECHANICAL PERMIT
�,� (All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall)
GENERAL INFORMATION
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 PERM[T. WORK MUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical Desi�ns—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 QF PERMIT
(Check All That A 1 )
[�Residential ❑Commercial(Approval Required)
❑New ❑ Additional ❑ Repairs ❑ Replace
Job Site/Owner Information:
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Site Address: �,Q.�Q,U �u��ClY(,1; N1 V
Owner: �. Mailin Address: f � Y� ��
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c.ty: (� Y0 ►'� D zr�: �5�`��
Home Phone: ��c '��� "7C��� Alternate Phone:
Contractor Information:
Contractor: , y.:. , , s> � --. Contact Person:
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:_�E.:� �`-�'661 �.�'a�. ��.�., �Uii� `.�� rn � ll����L��
Address: _ 4�2 State Bond #:
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City: '`- ���-<''"� ''"" t�Z�p'%E,:;l 7,2���iration Date:
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Phone: Alternate Phone:
❑ Insurance—Current:
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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: (� ��(���j� �
Wood Burning Fireplace �
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Masonry
VENTILATION
❑ No. Kitchen Exhaust duct recirculating cfm
❑ No. Bath Exhaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfm
FUEL STORAGE (Must be approved by Fire Marshal[ijproposing 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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� PERMIT FEE CAL,CULATION(5) �
� BASED OFF -2002 �`�A`�'E STATUE
❑ Yes,this section applies
The replacement of a Residential fixture 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 ne�ct section,if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $
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If above does not apply;follow guidelines below:
]. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00)
1 15` U x.O l 25 $ ��� ��
�(contract price) (minimum 550.00)
2. STATE SURCHARGE (]O
x.0005 $ ��I
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERM[T FEE(Add Lines l-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 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.
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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:
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