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' CITY OF ORONO * Z 0 1 3 - 0 0 3 7 0 *
2750 KELLEY PARKWAY DATE ISSUED: OS/16/2013
ORONO, MN 55356-
(952 249-4600 FAX: (952) 249-4616
ADDRESS : 30 MYRTLEWOOD RD
PIN : 36-118-23-33-0011
LEGAL DESC : MYRTLEWOOD
: LOT 003 BLOCK 001
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL-MULTIPLE
VALUATION : $ 7,476.00
NOTE: (1)LENNOX FURNACE-NATURAL GAS
(1)LENNOX COOLING SYSTEM-3-1/2 TONS
APPLICANT MECHANICAL 93.45
MARSH HEATING&AIR COND STATE SURCHARGE MECH(VALUATION) 3.74
6248 LAKELAND AVE N
MINNEAPOLIS,MN 55428- TOTAL 97.19
(763)536-0667
OWNER
PAULSON,BRUCE&LORI
30 MYRTLEWOOD RD
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 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 wi[hin 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 aze
requested in conformance with the State Building Code.This permit may be
revoked at time for du ise.
� s� /6 � 13 � � ,
Applicant P itee Signature Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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•
F�2 CI Y USE ONLY
�O^ 'O City of Orono � �D j� �-j���
�V P.O.Box 66 Date Receivcd• Permit# CJV
2750 Kelley Parhway
Crystal Bay,MN 55323 Approved By: Amount$: �7. l
� � l Phone(952)249-4600 Fax(952)249-4616
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��,��`,��.` ' CITY OF ORONO—MECHANICAL PERMIT
(All Cominercinl permits must be approved by the 13uilding Of�ici�l or Inspector and/or Fire Murshall)
GENERAL INFORMATION
l. You may apply for mechanical permits by mail or in person at the City oftices. 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 B�GIN UNTIL THE
PGRMIT CARD IS POSTED ON THG 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/l�eat gain calculation,design temperatures,equipment ratings and identitication 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
ob[ained.
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 m�ist be submitted before final.
TYPE OF PERMIT
(Check All That A 1 )
/
[v]�Residential ❑ Commercial(Approval Required)
❑ New ❑ Additional ❑ Repairs �v Replace
Job Site/ Owner Information:
Site Address: ,� `�'��'r -'t y�\ti��.�.:x�� I�� , C1;��CI1G
Owner: �...GYI �'��Gf7 Mailing Address: �'� �1"��)�/1 -� �e.ti1��C� �
City: CrGI��C; Zip: �cJ�Jq (
Home Phone: ����:�. ���]'� {' 1.�.I Alternate Phone:
Contractor Information:
Contractor: �1"`'i{�1 Ned�-it1� ;Al�ontact Person: �iC,l I�/ M�i�S,j i
Address: �2�� L��e Id!`d I�Y�..�.I State Bond#: M�C1C�'J53 �'_
City: ',{�t GG�� ' �h Zip:5�`{I��Expiration Date: ���;�2�'s I'-�
Phone: '1lc'J-5�10 �Gl.clr�% Alternate Phone:
[� Insurance—Current:
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MECHANICAL SYSTEMS BEING INSTALLED
Note: All Geothermal Systems will now rec�uire a Site Plan& Review by our Building Official.
,
IS THIS GEOTHERMAL? ❑ Yes [�No
EIGAT[NC SYSTEMS
Quantity: �
Make: �,fl(1C�
Model: �j1,;�1�(�1-�� �OXVl1CC,.
Fuel: F�d-��Ll,ld� ��ci,`J
Flue Size:
Input f3TUs: � �Q
Output I3TUs: ���D
CFM:
COOLING SYSTEMS
Quantity: �
Make: � 1J IlU)�
Model: xC,�1 —��2-2.3�J
���,s: 3 �/2 -�C,nS
►-i. i��w-er
FIRCPLACGS
❑ Gas Factory Fireplace Brand Name:
❑ Wood Burning Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Masonry
�'GNTILATION
❑ No. Kitchen Exhaust duct recirculating cfin
❑ No. Bath Exhaust(must have duct outside) cfm
❑ No. Other Fans: Locations cfm
FUEL STORAC E (Must be npproved by Frre Mars/�al/if proposing to aGandoiz tank in place.)
❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑ [nside ❑ Outside
LP Gas: gallons
Other:
GAS LINL ONLY
❑ Outdoor Grill ❑ Other/List What& Where:
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PERMIT FEE CALCULATION(S)
BASED OFF - 2002 STATE STATUE
❑ Yes,this section applies
The replacement of a Residential fixture or a��pliance that meets all three of the following requirements:
1. Does not require modification to electrical or gas service.
2. Has a tolal cost of$500.00 or less;excludin�the cost of the fixture or appliance: and
3. [s 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 $
PERMIT FEE CALCULATION S -JOBS OVER $500.00
IPabove do�s not apply; follow guidelines below:
1. CONTRACT PRIC� * is 1.25%of contract price�vith a(�linimum Fee of'$50.00)
_�f�--7lr.�� X .oi2s $ �3. ��5
(contract price) (minimum$�0.00)
2. STATE SURCHARGG (
---1�_}--��, G�. x .0005 $ �, �7�-1
(contract pricc)
3. POSTAGE& I-IANDLING (Only on Mail-In Applications) $ �-60'
4. TOTAL PGRMIT FEE(Add Lines 1-3 Above) $ � �, ��
• * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for tlle
permitted work includin� materiafs, labor, protit, 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 ofi such items must be added to the
estimated cost or eontract 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 eopy of the actual contract.
MECHANICAL PERMIT APPLICATION AGREEMENT
The tmdersigned 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 tl�is application are complete, true and
correct.
Applicant's Signature: _�o���;1� �y��' }Q,{�1 Date: � - ��—��_
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