HomeMy WebLinkAbout2017-00704 - mechanical r CITY OF ORONO * z 0 1 7 - 0 0 7 0 4 *
2750 KELLEY PARKWAY DATE ISSUED: 06/26/2017
ORONO,MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 2780 COUNTRYSIDE DR W
PIN : 04-117-23-12-0010
LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN
: LOT 002 BLOCK 002
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURE
VALUATION : $ 500.00
NOTE: REAPLCE GAS DRYER
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 0.25
MN PLUMBING&APPLIANCE INC. NIAIL-IN FEE 2.00
14105 RUTGERS STREET NE
PRIOR LAKE,MN 55372- TOTAL 52.25
(952)469-8341 Payment(s)
Minnesota State License#:cont-58455-PM CHECK 9054 52.25
OWNER
PETERSON,TIM
2780 COUNTRYSIDE DR W
LONG LAKE,MN 55356-
AGREEMENT AIVD 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 dces
not grant permission for additional or related work which requires separate
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 l80 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 permit may be
revoked at any time for due cause. �
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Applicant Permitee Signature Date Issued ignature Date
� FU U��S3NLY
` ' �..011T P.BoxQrona RECEIVED �� r��t� ��;��,�.. �
� � 2750 Kelley Farkway �
Crystal B�y,MN 35323 q��7 �ppr�►vod Bp: ��mo�tnk S:�
Phone(952)249�600 �4��49•�}916
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�{q��,s��4,F.�' CIT�1�R�-MECHANICAL PERMIT
(All Commeecial permits niust be approved by the Building pf�'icial ar Inspector and/or Fire Mershall)
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1. You rnay apply�or mechanical permits by mail or in person at tha City offices. Applications will
be revi�w�d and a permit will hs issu�d within two worki��d�ys.
�. Permit cards wi1D bs s��t by e�turn tnail after�r�view is cqmpi�ted. P�RMITS ARE N�T
V.ALIL?UA1T�I,YpU R���[V�'A PEF�MI`f. I �
FERiVIIT GARD 1S�QSTFD 9N TH�JO��a11'�.
3, ,M,� h�r�i�,c�,gi�s—CQmplete c�lculations,details arrid speaif�atians are reyuired f�r�ach
hsating,ventil�tion,humidifi�ation�d�humicJi#icatit�n,at�d air conditioning installatiQn including
heat loss/heat gain cal�ulatic�t�,d�si�n tennp�r�tures,��utprnent rati��s az�d id�nti�ication as to
type.mat�ufacturer a�d model. Qat�sh�ll be pr�s�r►t�d c��farm provid�d,
4. Whsn�ny new c�nstru�tion�r r�mod�ling is ir�volv�c�,�soper�t�building psrmit rr�us�b�
ol�tained.
�. A�1 wnrk must b�dQn�in�ce�rd�nce with th�[,Jr�if�z�tn,lVtccharii��l Code/�t�te�uilding�pde
r�quir�ments.
6. Ali work must be in�p�ct�(raugh-in and fin�l). G�ll(9S2)2���4600.
(24=a8 hpar a�tis��requtre�l)
7. �ou�e Heatin�T�st��c��d muat b�submitt�d t��fQr�fn�l.
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�Ii�sid�nt�al �Gomm�t����l(t��prav�l I��qui��d� ��ack�l��v f,3evic�; � AV� ��Vs�
� t�ew �t��ditian�l �I�airs �,Repl���
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��nr�e Pho�;e; ���;.��--�I,�ic�. Al��m�t� Fhc�ne: _
:�t�i��r I�'+���ttiz��;
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Cc�n�r�ctc�r: ��i u}��+�r�ta�t P�rson: ���,
Addz��s: c �-• IV� St�t��3o.�d#; ,_,���Q��
�ity: �ip�3y°� �x�iratie��T�ate: ,a _
Phc�n�: q So�- �g�' A�t�rri�.t� Pho��:
� In�uran����urrent: �
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Note: All Geothermal Systems will now require a it Pl & vi w by our Building Official.
IS THIS GEOTHERMAL? Q Yes �No
HEATING SYSTEMS
Quantih'� .�.
Make:
Model:
Fuel:
Flue Size:
Input[3TiJ�: �.,�._. ...��,.�,. _.�.��
C)utput BTUs: �
CFM:
�OQLING SYST�MS
Quantity: _._. .� .�-�
Make:
Model:
Tons:
H.Pow�r n�� ,_.._.�z _
�'IREPLAC�S
�] �a�Factory Fi��place Brand Name:
(� Wood Burning Fireplace
C] Wood St�ve Model No.:
� Wood Stove with Flu�(Ma�anry
,V,�,N'�I,L�,T�ON
No. I�itchen Bxh�ust du�t r�ciroulating cfrn
No. � Bath Exh�t�st(must have duct outside) c&n
No. pther Fans: Lacations c&n
��1E,�S'��,�$.�,(1klust b�ap,proued/�,y Flre A�arshal/#f�t��tos�ng to abandoa tank in plac�)
[] Installation Q R�moval
Fuel Oil: ��gallans [� Undargrqund ❑ Inside (�Outside
LP Gas: �allons
Other:
S$.��.�,�.�'s.�Y
(� Outdoor Grill ❑ Other/List What 8c Wh�re:�,� �
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1 �- ��S 1-�'
� � .
1. CQNT�tACT PRIGE * is 1.25%of contract price with a(Minimum Fee of$50.00)
�� . � x.0125$ 7� ' ��
(contract price) (minimum 950.d0)
2. S�'�,'�E SIT,RC,�,AI�'� �
X.OQQS $ � a�
(contract price)
3. POSTAGE&HANI�LING(Only on Mail-In Applications) $ „�,00 �
.�
4, TOTAL PERMIT FEE(A.d�Lir�es 1-3 Above) $ J�� • c�,�
� * CONTRACT FRI�E or JOB C(jST means the aett�al or estirrxated dollar amount charged for the
permitted wark including nnaterials, lab4r,prc�fit,and other fixed cost�. It is the amount to be Char�ed
to the custorner for the work dnne. If�ny matsrial,�quipment,labor or installatians are furnished by the
owner, tenant or any oth�r party, the r�asonabl� �narket value of such items must be added to the
estimated cost or contract price for ger�it fee purp�ses. In the event that there is a dispute on the amount
of the job cost, the City may request the subcnission of a signeci copy of tha actual contract.
The undersigned her�by appli��tn the �ity for issuan�� of a Mechanical Permit, agrees ta do all
wark in striot acc�rdance with th� ardir�ane�s f ttte City and the regulations o€ th� State of
Minnesota,and c�rtifies that tat�m�nts mad on this application are camplete,true and correct.
` ��Ap�plicant's Signature: Dat�: lY o��
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