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CITY OF ORONO *2 p� 1 6 - 0 1 3 8 z *
2750 KELLEY PARKWAY DATE ISSUED: 10/3U2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1550 NORTH ARM DR
PIN : 08-117-23-33-0074
LEGAL DESC : HICKORY HILL
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : COOLING SYSTEMS
VALUATION : $ 3,900.00
NOTE: RUUD COOLING SYSTEM-MODEL RA1324 AJ1NA-2 TONS
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 1.95
CENTERPOINT ENERGY MAIL-IN FEE 2.00
6161 GOLDEN VALLEY RD
BUILDING A TOTAL 53.95
GOLDEN VALLEY, MN 55422- Payment(s)
(763)512-2765 CHECK 20648 53.95
Minnesota State License#:mech-MB003503
OWNER
PELTOLA,MARGARET
1550 NORTH ARM DR
MOUND, MN 55364-
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 docs
not grant pennission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or no[specified herein.This permit will
expire and become null and void if construction au[horized 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 permit may be
revoked at any time for due cause. '
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Applicant Permitee Signature ate ssued B ignature Date
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�CI Y USE ONLY
�O • City of Orono /
1 � P.O.Box 66 Date Receiv � Permit#�� �
2750 Kelley Parkway
O Crystal Bay,MN SS323 Approved By: Amount$: ������
Phone(952)249-4600 Fax(952)249-4616
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`9kESH���G CITY OF ORONO—MECHANICAL PERMIT �
(All Commercial permrts must be approved by the Building Ofticial or Inspector and/or Fire�������
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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 PERMIT. 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 I-Ieating Test Record must be submitted before final.
TYPE OF PERMIT
(Check All That A 1
� Residential ❑ Commercial (Approval Reyuired) [Backflow Device: ❑ AVB ❑PVB]
❑ New ❑Additional ❑ Repairs ❑ Replace
Job Site/Owner Information:
Site Address: 1550 NORTH ARM DRIVE
Owner: MARGARET PELTOLA Mailing Address: 1550 NORTH ARM DR
City: MOUND, MN Z�p: 55364
Home Phone: 612-868-0156 Alternate Phone:
Contractor Information:
Contractor: CENTERPOINT ENERGY Contact Person: JOANN ZINKEN
ACIC�PeSS: 6161 GOLDEN VALLEY RD,BLDG A state BOrid #: MB003503
City: GOLDEN VALLEY Zlp: MN Expiration Date: osi2oi2o�s
P�"lOrie: 763-512-2765 Alternate Phone:
OLD REPUBLIC INSURANCE CO.
❑ WORKERS COMP&EMPLOYERS LIABILITY
IIZSUCa11Ce—CUrrent: POLICY#WLRCC48597075
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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: RUUD
Model: RA1324AJ1NA
Tons: 2
H.Power
FIREPLACES
❑ Gas Factory Fireplace Brand Name:
❑ Wood Burning Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove with Fiue/Masonry
VENTILATION
❑ No. Kitchen Exhaust duct recirculating cfm
❑ No. Bath Exhaust(must have duct outside) cfin
❑ No. Other Fans: Locations cfm
FUEL STORAGE (Must be approved by Fire Marshall if proposing 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 CALCULATIONS
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00)
3900.00 x .0125 $ 50.00
(contract price) (minimum$50.00)
2. STATESURCHARGE
3900.00 x .0005 $ 1.95
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 53.95
■ * 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.
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.
Applicant's Signature: Date: 10/25/16
3
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CITY OF ORONO CALLED IN ✓ I 46
INSPECTION NOTICE �SCHEDULED Iii
PERMIT NO. < C/ti—/7 /' COMPLETED
ADDRESS /6,{- 6) AL, / ,�I 1/ //3, ,
OWNER ; . 10A q 1'27! f ll�
TELEPHIONE NO. 7A - ',/)
CONTRACTOR ._,e/L >.' 9/A/
DESCRIPTION ` " '�
W 0 FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL
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• ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING
❑ FOUNDATION WATERPROOF 0 PLUMBING FINAL 0 TREE REMOVAL
O
Z ❑ RADON SLAB 0 MECHANICAL RI 0 SITE INSPECTION
Q 0 FRAMING 0 MECHANICAL FINAL 0 RATED WALLS
• ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT
✓ FINAL 0 WATER HOOK-UP 0 FOLLOW-UP
/• ❑ AS BUILT-SURVEY 0 SEWER HOOK-UP 0 FOUNDATION/REMOVAL
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14,ccLu 0 WORK SATISFACTORY:PROCEED ,>11,,:JECT COMPLETE
W 0 CORRECT WORK&PROCEED O IE CERTIFICATE OF OCCUPANCY
0 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
✓ BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED
O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on site:
Inspector: .- j .IA
White Copyllnspector's File Canary CopylSke Notice