HomeMy WebLinkAbout2016-00673 - mechanical ` � ' CITY OF ORONO �
2750 KELLEY PARKWAY * 2 0 1 6 - 0 0 6 7 3 *
DATE ISSUED: 06/13/2016
ORONO,MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 3450 NORTH SHORE DR
PIN : 08-117-23-43-0021
LEGAL DESC : LYDIARDS PARK LAKE MTKA
: LOT 000 BLOCK 000
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL-MULTIPLE
VALUATION : $ 3,836.00
NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION.
REPLACE A/C UNIT
APPLICANT MECHANICAL 58.02
SEDGWICK HEATING&A/C STATE SURCHARGE MECH(VALUATION) 1.91
1408 NORTHLAND DR-SUITE 310 1�IAIL-IN FEE 2.00
MENDOTA HEIGHTS,MN 55118- TOTAL 61.93
(952)881-9000 Payment(s)
CHECK 16682 61.93
OWNER
ODDEN,WILLIAM
3450 NORTH SHORE DR
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed acwrding to
the approved plans and specifications,applicable City approvals,and the
State Building Code. T'his 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 governing this rype of work
shall be compied with whether or not specified herein.This pertnit will
expire and become null and void if construction suthorized 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 Signatwe Date Issued Signature Date
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/�F, R C Y USE ONLY
'�� Cit of Orono �q Y���y
�' �O�\ P.O Box 66 ���'��6�/ Date Received:'_✓�Permit# ��� ���
1 � �� 2750 Kcllcy P2rk�y /
� Crystal Bay,MN 55323 Approvcd By: Amount$: �[ �
� � Phone(952)249-a��Fa`�C�5����4616
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q,�F�,��."j C �'��10— MECHANICAL PERMIT
�,.�i� (All Commcrci� �rmits must bc.ipprovcd by thc Building Official or[nspcctor and/or Firc Marshall)
�GENERAL INFORMATION �
1. You may apply for mechanical permits by niail or in person at the City offices. Appiications will
be reviewed and a permit will be issued within two working days.
2. Pennit 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 Designs—Complete calculations, details and specifications are required for each
hcating,ventilation,humidification-dehumidification,and air conditioning installation including
heat loss/heat gain calculation,design temperatures,equipment ratings and identitication as to
type,manufacturer and model. Dafa 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 OF PERMIT
(Check All That App1y) �
� Residential ❑ Commercial (Approval Required) [Backflow Device: ❑ AVB ❑PVB]
❑ New ❑ Additional ❑ Rcpairs ,�] Replace
Job Site/ Owner Information:
Site Address: 3�"5� ��C��'L-����- ��n �`�-�
Owner: �' �' �' � G��-y�1 lvlaiiing �ddress: �"S� Iv G����-����- '���
City: !'��;!�'�vYLc Zip: ."�);5 Gf �
Home Phone: Alternate Phone:
Contractor Information:
Contractor: �� !�� " ��� ��-�L � -C'�<<'��� Contact Person: �����` ���G1,��G�,_
Address: /�� � �U��/V`�'Z,Iltia6'l G{ (��- State Bond#:
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City: �11'�V��6`�Z���,���ip:�jS�Z,u Expiration Date:
Phone: �S !� � �� �� G1 L'����' Alternate Phone:
❑ Insurance—Current:
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�E�HA���..��.'ST���B���`r,�5�"A�L��?�
Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS THIS GEOTAERMAL? ❑ Yes �No
HEATING SYSTEMS
Quantity:
Make:
Model:
Fuel:
. Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity: I
Make: VVl Q.V�.
Model: C�SI� I J 3�.2 �
Tons: �
H.Power
FIREPLACES
❑ Gas Factory Fireplace Brand Name:
❑ 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 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 CAI.�LILATI��'+�S n`
1. CONTRACT PRICE * is 1,25%of contract price with a(Minimum Fee of$50.00)
� O�v�, � xA125 $ sg, 02'
(contract price) (minimum$50.00)
2. STATE SURCHARGE
3 k3� . w X .0005 $ /- � r
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ (� �• � 3
■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
permitted work including materials, ]abor, 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.
�ti%IE��TAI'�I�AL'PE�TT'A�P� ':�"�+C��A����l��,� .� ,����� '�- ''.
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: � Y [ Date: �P'�—���
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