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HomeMy WebLinkAbout2018-00243 - mechanical CITY OF ORONO 1 1 I �I I 8� I� I III I I I I�I 2750 KELLEY PARKWAY DATE ISSUED: 03/05/2018 ORONO,MN 55356- (952)249-4600 FAX: (952) 249-4616 ADDRESS : 1050 COX FARM RD PIN : 27-118-23-32-0017 LEGAL DESC : SHADOWOOD FARM : LOT 007 BLOCK 001 PERMIT TYPE : MECHANICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : MECHANICAL-MULTIPLE VALUATION : $ 9,300.00 NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. (1)LENNOX HEATING SYSTEM (1)LENNOX 4 TON A/C APPLICANT MECHANICAL 116.25 STATE SURCHARGE MECH(VALUATION) 4.65 LIBERTY COMFORT SYSTEMS TOTAL 120.90 627 EAST RIVER ROAD Payment(s) ANOKA,MN 55303 CHECK 22704 120.90 (763)422-8760 OWNER ZONER,ERIC&DIANN 1050 COX FARM RD LONG LAKE,MN 55356 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. 3 . -1 .- -- . , h-J5 Applicant Pertn'i Date Issued By Si ture Date ffffff � �J FOR CITY USE ONLY �OA,a City of Orono P.O.Box 66 Date Received: Permit# 2750 Kelley Parkway 0111L. Crystal Bay,MN 55323 Approved By: Amount$: Phone(952)249-4600 Fax(952)249-4616 A ` �1 ' CITY OF ORONO-MECHANICAL PERMIT lk@S H OV. (All Commercial permits must be approved by the Building Official or Inspector and/or Fire Marshall) 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 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) bd Residential ❑Commercial(Approval Required) [Backflow Device: ❑AVB ❑PVB] ❑New ❑Additional ❑Repairs Replace Job Site/Owner Information/:r�' � Site Address: 1, ` �~ `--C .. I-- R K in / L)G' 4 0 Ownenedc 4 I L 0 t{L le___ Mailing Address: 0 i'%_ City: ( Oil q 14'1 e C Zip: -6-.9 3 S J Home Phone: Alternate Phone: 9 6 D - 3 tv — g9(3 Contractor Information: I,1 Qom r� S Q 11\5Contractor:L 1 ".t`"-f7 cw 1 act ST; r,l n'1 i3 ' I W e i( l LL .� Address: 4,21 T 1\P\%e✓ (bState Bond#: () Cl rJ1AZi I 417118.1 City: }1�p�Gt p: Ij 3pration Date: Phone: To P7 4() Alternate Phone: (_, /,2 - 3L3-- ?9 i d /'n ., Insurance-Current: JLC 1k r-•6. --- 1 MECHANICAL SYSTEMS BEING INSTALLED Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. IS THIS GEOTHERMAL? ❑Yes ❑No HEATING SYSTEMS Quantity: l Make: L i T 1" b S Model: 5"/_,,) Y1 Lk 14 /36Y 4) Fuel: Flue Size: Input BTUs: Output BTUs: 13 J�Lt C?d CFM: COOLING SYSTEMS Quantity: 1 Make: L eL ir(J( yL Model: 1; I,�, Xe. j — -3 C Tons: H.Power FIREPLACES ❑ Gas Factory Fireplace Brand Name: LIWood 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: 2 PERMIT FEE CALCULATIONS 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) C` c } c � x.0125$ (contract price) (minimum$50.00) 2. STATE SURCHARGE x .0005 $ (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ I A0 ‘90 • * 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: V.. �., �,n�.C� Date: 3 ^....iii LIBECOM OP ID:TN "COREY DATE(MM/DD vvYv) 4.......--- CERTIFICATE OF LIABILITY INSURANCE 10/12/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 651-209-9330 CONTACT Tim Newton Eagle Point Insurance PHONE 8665 Eagle Point Blvd. (A/C,No,Ext).651-209-9330 FAx 651_209-8332 Lake Elmo,MN 55042 E MAIL I(A/C,No): Tim Newton ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Secure Insurance 22543 INSURED LIBERTY COMFORT SYSTEMS,INC Liberty Heating&Air Cond DBA INSURER B 627 East River Road INSURER C: Anoka,MN 55303 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE JNSO WVD POLICY NUMBER fMM/DD//YYYY1 (MM//DD//VYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE - $ CLAIMS-MADE I I OCCUR TC3198409 10/13/2017 10/13/2018 DAMAGE TO RENTED 100,000 A PREMISES(Ea occurrence) $ CP3198413 10/13/2017 10/13/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY Included GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY I I JECT I I LOC PRODUCTS-COMP/OP AGG $ 2,000,000 ' OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO A3198410 lEa accident) $ 10/13/2017 10/13/2018 BODILY INJURY(Per person) $ _ AUTOSWNEONLY x SCHEDULED _ E AUTOS Ep BODILY INJURY(Per accident) $ X AUTOS ONLY X NON-O ONLY PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAR X OCCUR $ EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE CU3198412 10/13/2017 10/13/2018 5,000,000 AGGREGATE $ DED X RETENTION$ 10,000 A WORKERS COMPENSATION $ PER AND EMPLOYERS'LIABILITY STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE (II WC3198411 10/13/2017 10/13/2018 500,000 FFICER/ME M EXCLUDED? I N/A E.L.EACH ACCIDENT $ EiCER M In�V 500,000 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ r DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Property Section TC3198409 10/13/2017110/13/2018 A Builders Risk TC3198409 10/13/2017',10/13/2018 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION CTANOK1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Anoka THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2015 1st Avenue N ACCORDANCE WITH THE POLICY PROVISIONS. Anoka,MN 55303 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) I ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD