HomeMy WebLinkAbout2013-00681 - mechanical ` ' CITY OF ORONO
2750 KELLEY PARKWAY * 2 0 1 3 - 0 0 6 B 1 *
DATE ISSUED: 07/19/2013
ORONO,MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 4315 NORTH SHORE DR
PIN : 07-117-23-43-0028
LEGAL DESC : SAGA HILL REVISED
: LOT 000 BLOCK 018
PERMIT TYPE : MECHANICAL(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : MECHANICAL-MULTIPLE
VALUATION : $ 111,420.00
NOTE: GEOTHERMAL
1 LENNOX NAT GAS FURNACE
2 WATER FURNACE
1GAS LINE TO FP
1 KITCHEN EXHAUST
6 BATH EXHAUST
GAS LINE TO OUTDOOR GRILL
APPLICANT MECHANICAL 1,392.75
SELECT MECHANICAL SERVICES INC. STATE SURCHARGE MECH(VALUATION) 55.71
6219 CAMBRIDGE ST
ST. LOUIS PARK,MN 55416- MAIL-IN FEE 2.00
(952)926-4488 TOTAL 1,450.46
OWNER
CLEVELAND,BRADLEY&PAT
4520 JLJNEAU LANE N
PLYMOUTH,MN 55446-
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. T'his 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 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.1'his permit may be
revoked at any time for due ca se.
��,1�C�C.c��.� 7/ �L7/ l 3 y � / �
App lican t Permi tee Signa t ure Da te ssu y ignature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
.
F � ,
FOR C11'Y USE ONLY
�O A'O City of Orono � D ��'
�y P.O.Box 66 Date Received: Permit�l
2750 Kelley Parkway
Crystal Bay,MN 55323 Appraved By: �Amount$:
Phone(952)249-4b00 Fax(952)249-4616
y� �
��kfSHO��'G CITY OF ORONO-MECHANICAL PERMIT
(All Commercial permits must be approved by the Building OfficiaJ or Inspector andlor Fire Marshall)
GENEItAL IATFQRM�T�ON
1. You may apply for mechanica!permits by mail or in person at the City offices. Applications will
be reviewed and a permit will be issued within two working days.
2. Permit cards wiil be sent by retum mail after a review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical Designs—Complete calculations,details and specifications are required for each
heating,ventilation,humidification-dehumidification,and air conditioning installation including
heat loss/heat gain calculation,design temperatures,equipment ratings and identification as to
ty�,manufacturer and model. Data shall he presented on form provided.
4. When any new construction or remodeling is invotwed,a separate building permit must be
obtained. '
5. All work must be done in accordance with the Uniform Mechanical Code/State Building Code
requirements.
6. All work must be ins�cted(rough-in and final). Call(952)249-4600.
{24-48 hour notice required)
7. House Heating Test Record must be submitted before final.
TYPB OF PERMIT
Check Ali That A 1
[�Residential ❑Commercial(Approval Required)
/ �
�New ❑Additional ❑Repairs ❑Replace
Job Site/Owner Inforn�ation:
Site Address: �✓`��U�T�-! �i��D� �i�/li�
Owner:����D �4 Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Ccx�$ractor In��rma�ion:
Contractor: ��Z�2sr/����A/U�IA�- Contact Person: ��Lt-�C��`K'0�
Address: �19 ����`s` State Bond#: /�?.B ��33�J
City: J7�L�diS �i�� Zip:�l{o Expiration Date: 9���3
Phone: ��- /d��7�� Alternate Phone: 1�a�- ��S'����
❑ Insurance-Current: f/� � �C`���I���
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�t ,;, �; �� '� v� w�����'�a'4�0��1� ,t„i�.�
Note: All Geothermal Systems will now require a Site Plan& R view by our Buiiding Official.
IS THIS GEOTIiERMAL? �Yes ❑No
HEATING SYSTEMS
Quantity: ( { �
Make: ��crVN�c wR'ita2���1r�"i,�l,vP�,
ModeL• F.JL-o�i�+ �n?..�tcs�i /�lSvt3 D,S7�
Fuel: �D Q��L— �.2
Flue Size: 3,�(/iJL ^ `—
Input BTIJs: ��i�� '— '—
Output B'TUs: �o�L� �
CFM: I� "— �—
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons:
H.Power
FIREPLACES
'� Gas Factory Ficreplace �S�'��� Brand Name:
❑ W�d Burning Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Masonry
VENTILATION
'� No. � Kitchen Exhaust � duct recirculating �U cfm
'� No. � Bath Exhaust(must have duct outside) S� cfm
❑ No. Other Fans: Locations ��
FUEL STORAGE (Must be approved by Fire Marshall if propnsing to abandon tank in place.)
❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑Inside ❑Ouuide
LP Gas: gallons
Other:
GAS LINE ONLY
� Outdoor Grill ❑ Other/List What&Where:
2
' , .
��u �" vi��'� �T'�'�7��; � a'�y�+„ �' � - � �`� � aY�i��4"�� � ��.xs�'�^���"i`y�,:�eYe�k�+j
�irq a�`39��� sk�� tr�;"� s� � � 4. ��, �� ' '�a t��ik�"� Yv�4`�r�r'�<f�r�� ,��i� � s��u � nh�4,
s� ���eu � 2�i�', a� ,n ���' w $ � � ti� n7'�t��k ��',1�ii�����'�'�P�S�'
�g+�,`��r�r,��r15�N�"�' , 7� ��� %�, w ��,, �,'���` ,� �tin�°�d �rP.��! ��+��Y;"'^ �hs �a
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❑ 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 t cost of$500.00 or less;exclu in the cost of the fixture or appliance:and
3. Is improved,installed or replaced by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surchazge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $
y�'��Y k ��� ,„. .e;f,yr�Y " ,rW�'i� r sa.'�4� a.s�i��� '+ �a� .
(r'+u ��i:��C� 34��y"' �k�� :N3+'�� d� ,'h. "�'� �.;�,!� b',.'l3�a +�L'k. ��dll�,_
If above does not apply;follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
� �[ �-f�� X.oias$ I 35a,�7�
( uact price) (minimum$50.00)
2. STATE SURCHARGE �����y�
x.0005 $ ��'��
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �`��'�b
■ * 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
esrimated 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.
�^���1 C�,��t�a'� '�j R����:, c'_.�r: o IF`„ �; `'J `�IKl:�� ar , S c,��,
_r��x�i ",.�!��2,t��a��
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
conect.
Applicant's Signature: - Date: �—/� /�
3
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MDH USE ONLY
� MQMYESOTA DEPARTMENT OF HEALT[i Date Received
Well Manageme�t Se�ion Amount Received
P.O.Box 69502 Application No.
SL Paul,Minnesota 55164-0502 ❑ $235 Vertical Heat Exchaz►ger<10 Tons (493n
� 651-201-46D0 or 500-383-98Q8 ❑ $475 Vertical Heat Exchanger 10 W SQ Tons (4938)
Fax No. 651-20[-4599
Deaf and hard-of-hearing: TTY 651-201-5797 ❑ $700 Vertical Heat Exchanger>50 Tons (4939)
Schematic of Plumbing Design
Applicattoa fo�per�it to iostsli a vertical heat exchsage device(esrth- ���� Approved
conpl�i h�t loop)pursaant to Minnesota Statvtea,Chapter 103I aed Site Plan Showing Isolation Distances
rules adopted t6ereuoder. Received Approved
Logs of the Holes,if Existing
(IYOTE: Make check payable to: Minnesota Department of Health)
Indicate Heating/C�ling Capacity: ❑<10 Tons �10 w 50 Tons ❑>50 Tons
Geaeral Project Data to he completed by a11�plicants(please print or type all information provided).
Name of Certified Representative DBVId P. H@I1riCh Cectified Repr�esentative No. 1205
Company Name Bergerson-Caswell, InC Company License No. 1767
Telephone No.(including area code) 763-479-3121
s�t pddr�s 5115 Industrial Street
ciry,sr�ce,ana z�coae Maple Plain, MN 553359
applies for a permit to install a vertical heat exchanger device(e�rth-coupled heat I�p)as hereinafter set form or as disclosed by
atf�ched supporting data.
1. A.Legal D�cription of Verti�l Heat Eachanger(VHE).
Township Range Section Quarter(s)
County Township Name No. No. No. Smallest—�Largest
Hennepin Orono 117 23 7 NW '�4SE '/4NW !4 !4
B.VHE Imcatioa Site Address
Address
315 North Shore Drive
City S� ZIP Code
rono MN 55364
2. VertiCal Heat Eachanger Owner Mailing Addr�s.
Name
�P.P.ii7 C L.�N D
Address
�l3/S' NvRTy s o� Q�vE
C� g� ZIP Code
OQonia /Y1 N s"S
3. Property Owner Addr�ss(if different t6an the Vettical Heat Facchanger Owner Mailing Address).
Name
Address
Cily
State ZIP Code
�
, • , . , .
4. Descriptioa of the Vertical H�t Eac6aager—Coustructioa Detail.Please supply the following infora�ation where appropriate.If ttue vertical
heat exchangers ere not yet c;on�ucted,writc in the estimated depths,size,c,and dates.
Number o oles Hole Depth{s) DiameOer of Piping(s) Antici�ted Depth to Bedrock
�2 �5 3/4" 268'
fiping Material
� High D�msity Polyethyle�e ❑ O��
Grouting Material
❑ Neat Cement ❑ Cemem Sand � Bentonite ❑ 'Chermally Enhanced Bentonite ❑ Other
Heat Tranafer Fluid
� USP-Grade or Food-Grade Propylene Glycol ❑ Other
5. D�eeriptioa of the Hest Pump Unit
Neme of Manufacturer Model No. Maximum Flow Rate
wAT6�f'rJr2/�1 H%� ~�2 ��Y Z� gpm
Name of i�amller
SEr�� M�ta-t �c�►►`. 5�R�/r��5
�9��� Installation I)ate(Ach�al or Propased)
Maximum �t0 Minimum � P 1 O — 1 ^ ( '�j
6. Location ot Vertical Heat Exc6aager.
Indicete the location of the vertical h�t exchanger on an attached site plan showing isolation distances fcom water-supply wells,
power lines,gas lines,LP tanks,buildings,and property lines.
The site alan diagram mast be attachaf.
As a condition of this pemut,I agree to construct this vertical heat exchanger under the provisions of NGnnesota Statutes,
Chapter IQ3t and the rules adopted nnder it.
Signature �
(Certified Representative) (mm/dd/yyyy)
As a condition of this permit,I agree to operate and maintain this vertical heat exchanger under the provisions of Minnesota Statutes,
Chapter 103I and rules adopted thereunder and to allow inspection by the commissioner of health or his/her agent during regulaz work
hours.
D� July 1, 2013
Signature
Owmer of Propercy) (�d�riri)
origs�FJeat Loop Application and Memo.doc 7l21/201 I R
2
}%� qATE TIME
1 CITY OF ORONO �
INSPECTION NOTIC �Q' SCHEDULED '�
PERMIT NO. � COMPLETED
ADDRESS J?" I JN n` S G't I�l"� ,��-
OWNER TELEPHONE NO.���a`��a
CONTRACTOR �e f�-�''� f�'����2
� DESCRIPTION ��S Ll�'l� ` (�/ r���
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Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
_ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
v ❑ DEMO-SITE ❑ SEPTIC IN L ❑ FOUNDATION/REMOVAL
2 OWNEWCONTRACTORTO MEET YOU:_YES NO
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INSPECTOR W{LL RETl1RN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTlONREQUIRED.CALLTOARRAN(3EACCESS.
Ca inspection 2a hours in advar�. (952) 249-4600
Own lCorrtractor on s e: �����
�
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White Copyflnspecto�'s flle Canary CopyfStte Notfee
�� D TIME y
CITY OF ORONO CALLED IN 7��
INSPECTION NOTICE SCHEDULED �� :�
PERMPTNO.a�f3-�DO�o� � COMPLEfED
ADDAESS �3�S N�"�'�- S�-� �'
OWNER TELEPHONE NO.�SZ uS �DJ`�S
CONTRACTOR ����'-10 /�L�C-�LfiJ'u G�
� DESCRIPTION l�a�x���T��� �
� ❑ FOOTING ❑ PLUMBING FINAL � EXCAV/GRADING/FIWNG
Q ❑ POURED WALL `�MECHANICAL RI 0 LAKESHOREANERANDS
y ❑ FRAMING ❑ MECHANICAL FINAL
❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNERlFIREPLACE ❑ SfTE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROdRESS
� � FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
v p DEMO-SITE 0 SEPTIC MAINT. ❑ FOLLOW-UP
i ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNbATION/REMOVAL
2 OYYNERHANTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
� �v�.i - �aor .Q
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0 O CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFOREC01/ERINd PERMANENT
O CARHECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ��TA710N ISSUED
❑INSPECTION REQUIRED.CALL TO ARRAN(iE ACCESS.
Call for the next inspectfon 24 hours in advar�ce. (952) 249-4600
OwneHCorrtractor on site•
Insp�ct�: �
e copynnspeceors��e canary copy�sne Noace
� �� � TE �� TIME V
CITY OF ORONO CALLED IN � `•�
INSPECTION ,����-�l� �SCHEDULED (
PERMIT NO. �dJ COMP�ETED
ADDRESS � I S Q " � � . i� !�
OWNER � Cz- TELEPHONE NO.��'�� ����
CONTRACTOR ��-��� � ����C`-�"cZ�2
�: DESCRIPTION � � �� �
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Q ❑ POURED WALL ❑ MECHANICAL RI ❑ lJ\KESHORE/WETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL
Q ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
= O DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO
v�i COMMENTS:
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W
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDEH POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in dvan 249-46��
OwnerlContractor on site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice
� ATE �ME �
CITY OF ORONO CALLED IN '!
INSPECTION N TICE / SCHEDULED –/ �,Z.�'� —
PERMIT NO. -��` COMPLETED
ADDRESS ��`� �• c./�"1 ��
OWNER TELEPHONE NO. �J" ����01.��
CONTRACTOR
� DESCRIPTION � -
tN ❑ FOOTING O PLUMBING FINAL ❑ EXCAV/GRADING/FIWNG
Q ❑ POURED WALL ❑ MECHANICAL RI � LAKESHORENVETLANDS
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❑STOP ORDER POSTED.CALL INSPECTOR
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Ca11 for the next inspection 24 ho rs in advan , (952) 249-460�
OwnerlContractor on site:
Inspector.
White Copyllnspector's File Canary CopylSite Notice