HomeMy WebLinkAbout2016-01477 - mechanical -� CITY OF ORONO * Z 0 1 6 — 0 1 4 7 7 *
2750 KELLEY PARKWAY DATE ISSUED: 1U28/2016
ORONO, MN 55356—
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3120 NORTH SHORE DR
PIN : 09-117-23-32-0007
LEGAL DESC : CRYSTAL BAY PARK
: LOT 000 BLOCK 002
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL-MULT[PLE
VALUATION : $ 3,300.00
NOTE: (1)LENNOX NATURAL GAS FURNACE
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 1.65
OWENS COMPANIES, INC. MAIL-IN FEE 2.00
930 EAST 80TH STREET
BLOOMINGTON, MN 55420- TOTAL 53.65
(952) 854-3800 Payment(s)
Minnesota State License#: mech-Mb003718 CREDIT CARD 7497 53.65
OWNER
CREE,MARK&NANCY
3120 NORTH SHORE DR
WAYZATA, MN 55391-
AGREEMENT AIYD 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 separate
permits. All provisions of laws and ordinances governing 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 lA0 days at any time afrer 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 ermitee Signature Date Issued ignature Da e
Nov, 28. 2016 9; OOaM No, 4577 P, 3
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City of Orono � ` �) / (�` � 7 7
��� P.O.Boa 66 �a�c Rcceived: b ormic# � lJ
O 2750 ICallcy Porktivuy �
C�ysral Tiay,MN 55323 Approved By: Amount$:�3 ,�
phone(952)249-4600 Fax(952)249-4616
�`� `'~ CZTY O� O�20N0—MECHANYC,P�L pERMYT
l���s��R� (All CommcrCinl permi[S nlust be Ppprovcd by nc�Building OffiCiAl or InspeC�or&nd�or Piro Marshall)
�Err�x�L rn�o�tvr��zoN
1. You ma�+apply for rnechanical permits b�mail or in person at the City officcs. Applieations will
be reviewcd and a permi[wilI be issued within two working da�+s.
2. pernut cards will bc scnt by retuin maiI after a review is complctcd. PERIVICTS AR'E NOT
VALID UNTrT�'Y'OCJ RECEIVE A PERMIT. W012T�1VIT1S'r N4T�EGIN UNTIL THE
p�rtivZZ'X'CARD IS POSTEb O1V�THE r0�S�TE.
3. Meehanical Desi�ns�-Compltte ealeulaiions,details and specifications are require�l for each
hesting,ventilation,hurnidifiCation-dehumidifiCation,and air conditloning installatiou ineludittg
heat loss/heat gain calculation,design temperatures,oquipment ratings and ideatification as to
rype,manufactux•er and model. Data shall be preserlted on foa�m provided.
4, When any new constructio�l or remodeling is invofvtd,a separatc building permit must be
obtained.
5. All vvork must be done in accordance with the Uniforax�Mechanical Code/Sla�e Building Code
requircmtnts.
6. All work must bc inspected(rough-in and�naI). Call(952)2�9-46Q0.
(Z4-48 hour notice rec{ui�red)
7, House Hcating Tesr Reeord must be sub��itted bcforc final.
T'4'pE OF�ERMIT
Check A11 That A 1
�Itcsidential Q Coanmercia!(Appro�'al lZequired) [BaCkflow Device: ❑AVB ❑P�V$]
[] New ❑Additional ❑Repairs �keplace
Job Site/Owner Taaformation:
Site Address: � ��Q IJO�T�F S f��E ��I U�
Owner: R i C I�flR A f�o 2 �! Marling Address: � �� No�T�`S��E bR/�t�
Cit�� O�a iJ o Zip: Ss �3 9 /
Home Phone: �1� � ���-���� Alternate Phone:
Contractox Xnformation:
. �
Cantractor. ��-�L� ��'�s �A---e - Contact Person: �e rr n n c G����r
Address: �.�0 ��.s'� �Q� �t�l'rc.� State Bond#; M�Q����� ._
` �'��/�.o��
Cit�r: D d/ti`� h Zip:,�� Expiration Date:
phone: �I s� �7��'S `�a� Alternate phone:
❑ Insurance-Current: YL�
1
Nov. 28. 2016 9; OOAM No, 4577 P, 4
' :,�:::�... , � . . .
��,."; MEC�TAN���S'3�ST�IS E�TNG I1�ST�,LEb
N'ote,All Geothermal Systems will now rtquixe&Site Plan 8z Review by our$uilding O�f�'icial.
IS T�S GEOT���LIVIAL? ❑Yes �]No
r��Armc s�rsx��s
Qu��ry� (
Makc: ���6
Model: F�.'�9�a��1D70�E��
Fuel: ��✓
Fluc Size: o/C ___
InputBTUs; (U�i � �U
Output BT�1s: D o�
CFIv�: �•�g
%�fiar Nc..�t ��s = �s,z�2
COOLiNG SYSTEMS
Quantity:
Make:
Model: —
Tons:
H.Powes
FIREp�.AC�S
❑ Gas Factory Fireplacc Brand Name:
❑ 'VV'ood�uming Fireplacc
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Masonry
'V�N'Y'�.AxXON
❑ No. T�itchen Exhaust duct recirculating cfm
❑ No, Bath�xhausi(must have duct outsidc) cfn�
❑ No. Other Fans: Locations ��
F[lEL STORAG� (Mwst be Ayproved by Fire Marshn/!lf pwoposing to abandon�ank in place.)
❑ latstallation ❑ l2emoval
Fucl Oik gallons ❑ Uriderground ❑Inside ❑Outside
T,P Gas: galtons
Otl�er:
GAS LINE ON'Y.'Y'
❑ Outdoor Grill ❑ Other/List What&Where:
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Nov. 28, 2016 9: OOAM No. 4577 P, 5
� . �
,
,;�;�y ;-; , ,;. . . . pE�'IT F�E GAY,CCr1,ATY0I�TS . . „
1. CONTRACT PRICE �is 1.25%of contract price wi[h a(Minimum rcc of�50.00)
�� �00. �O x.0125�
(conlrac�price) (minlmum SSp.p 0)
2. STATESURCHARGE
x.0005 $
(cuntracl priCC)
3, POSTAGE�HANDLING(Oniy on Mail-In Applica�ions) $ 2.00
4, TQTAL PERMIT FEE(Add Lines 1-3 Above) S / �' �`�'
■ * CONTRACT I'RICE or JOB COST mcans the actual or estimated dollar amount chaa•ged for �he
perrnitted work includaa�g znate�ials, labor,profit,and other f►xed costs. It is thc amount to be charged
to che cus�omer for tl�e work done. Tf any material,cqu'rprnent,labor or'rnstaIlatioa�s are furnished by tl�e
owner, teaiant or any other party, thc reasonable market 'value of such items must be added to �e
estimated cost or coatract price for pernnit fee purposes. In the event that there is a dispute on thc a�nount
of thc job eost, thc Ciey may request the submission of a signed copy of the ach►al contract.
r� r; , W��;�r�i�a�,P��T��ic;rcAr�orr������� _ .
The undersigned hereby applies to the City for issuance of a Tv[echanical Pern�it, agrees to do all
work in strict accordanee With thc ordinanees of the City ar�d the ;re�ulatipns of the State of
Mi�nesota,and certifics that all stateme�ts tnade on tl�is application are complete,true and correct.
Applicant's Signature: �� `'d��'` Date: ��/ �-fl�•�D��
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