HomeMy WebLinkAbout2016-01514 - gas line only Ak
BEFEUMM
CITY OF ORONO * 2 0 1 6 — 0 1 5 1 4
2750 KELLEY PARKWAY DATE ISSUED: 12/05/2016
ORONO,MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS 220 NORTHGATE RD
PIN 36-118-23-41-0051
LEGAL DESC NORTHGATE TWO
LOT 001 BLOCK 007
PERMIT TYPE MECHANICAL
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE GAS LINE ONLY
VALUATION $ 1,000.00
NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION.
GARAGE UNIT SUPPLIED BY OTHERS. THIS PERMIT IS ONLY FOR HANG AND GASLINE ONLY
APPLICANT MECHANICAL 50.00
PROFESSIONAL MECHANICAL SERVICES
STATE SURCHARGE MECH(VALUATION) 0.50 18983 YORK STREET NW MAIL-IN FEE 2.00
SUITE C TOTAL 52.50
ELK RIVER,MN 55330- Payment(s)
(763)657-7421 CHECK 2595 52.50
Minnesota State License#:mech-MB003767
OWNER
DAU,EDWARD&MICHELL
220 NORTHGATE RD
WAYZATA, MN 55391-
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 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 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 Issued By Sijhature Date
• RE��IVED
City of OrortE(;
o FO C USE ONLY
P.O.Box 66 Date lteceiJ : 2 J/ Permit# �✓����
2750 Kelley ParkwayNQ
Crystal Bay, o ORQ Approved By: Amount$:
Phone(952)2Fax(952)249-4616
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!q'kfSHO �G CITY OF ORONO–MECHANICAL PERMIT
(All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall)
GENERAL INFORMATION
I. 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 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
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 Heating Test Record must be submitted before final.
TYPE OF PERMIT
Check All That Apply)
®Residential ❑Commercial(Approval Required) [Backflow Device: ❑AVB ❑PVB]
NO New ❑Additional ❑Repairs ❑Replace
Job Site/Owner Informaattion`:�
Site Address:
Owner: 1'll 4- (t., Mailing Address: ou o n tr�q C1A-ej
City: o Y(9'n u Zip: '217—-3 9 1
Home Phone: Alternate Phone:
Contractor Information:o
Contractor: j f 0�aS iContact Person:
Address: 1�ggS IUY�n(k) !S�t-- State Bond#:
City: E K (Zf1,,r Zip:�0 Expiration Date: '21 i 001 S
Phone: 3 jUr Alternate Phone:
❑ Insurance–Current: �?v�
I
MECH (8i S'x91tMS BEING INSTALLED
Nate:All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS THIS GEOTHERMAL? ❑Yes No
BEATING SYSTEMS
Quantity:
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
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 Dd Other/List What&Where: +0 C oK�
PERkIT1� ALGULATIQIVS
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
_1000 x.0125$ `fin 16D
(contract price) (minimum$50.00)
2. STATE SURCHARGE
11000 x.0005 $ 15D
(conhact price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ,-a -KV
■ * 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.
MECT AIVI AL-ftRl1+i3"P APPLICAPQN'ACikE
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 s ents made on this application are complete,true and correct.
Applicant's Signa Date: l` SO `;2al(,--
3
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CITY OF ORONO CALLED IN l
INSPECTION NOTICE71(
�J q SCHEDULED
PERMfT NO. -�( %�� �'/ COMPLETED
ADDRESS oZ c /`/U r-1-1t Gi GLt� 2�
OWNER TEL ONE NO.
CONTRACTOR r
DESCRIPTION `��
W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
2 ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
v ❑ DEMO-SITE ❑ FPTIC INSTALL
2 OWNEWCOWMCTOR TOGEi YOq YES. NO
COMMENTS:
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W ❑WORK SATISFACTORY-PROCEED OJECT COMPLETE
It ❑CORRECT WORK d PROCEED ❑, UE CERTIFICATE OF OCCUPANCY
W
0 L3CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
C.1 BEFORE COHERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR EI CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor It
Inspector.
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White Copy/Inspector's File Canary Copy/Site Notice