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HomeMy WebLinkAbout2012-00701 - mechanical CITY OF ORONO 1 1 1'' Till I' 111 !I * 20 1 0 0 7 0 1 2750 KELLEY PARKWAY DATE ISSUED: 07/24/2012 ORONO, MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS : 870 OLD CRYSTAL BAY RD S PIN : 09-117-23-12-0006 LEGAL DESC : FRENCH CREEK WOODS : LOT 002 BLOCK 001 PERMIT TYPE : MECHANICAL(>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : MECHANICAL-MULTIPLE VALUATION : $ 12,000.00 NOTE: 1 TRANE NAT GAS FURNACE 1 TRANE 4.0 AC APPLICANT MECHANICAL 150.00 TOTAL COMFORT STATE SURCHARGE MECH(VALUATION) 6.00 4000 WINNETKA AVE N SUITE 10 MAIL-IN FEE 2.00 NEW HOPE,MN 55427- TOTAL 158.00 0 OWNER LANNOM,CHARLES&SUSAN 870 OLD CRYSTAL BAY RD S 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. La-41 fw / / nQ-yL l l Applicant Permitee Signature Date Issued By Si atureate SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABBO'LE. FOR CITY USE ONLY ¢o City of Orono P.O.Box 66 Date Received: Permit# 2750 Kelley Parkway '')4 , 1 Crystal Bay,MN 55323 Approved By: Amount$: ) t`f,. 4. / Phone(952)249-4600 Fax(952)249-4616 CITY OF ORONO-MECHANICAL PERMIT (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) ❑ Residential ❑Commercial(Approval Required) ❑ New ❑ Additional ❑ Repairs ❑■ Replace Job Site/Owner Information: Site Address: g--7O CI c� IJL� O`� B R� 0\nom Owner:�j rips d-SUI.S@1 Mailing Address: 7O u �a- City: 010110 Zip: 3q Home Phone: (IS-a LI)33*(c0.T) Alternate Phone: Contractor Information: Contractor: l}—a1 N Al tIri— Contact Person: k 1 4"'oar'LLt Address: Zt) wt11i'Vific-Ck_AV eState Bond#: City: 1\leka4DpeC Zip:555'12j Expiration Date: 9 -30-do/ I Phone: 7 b3-383 8 3S 3 Alternate Phone: 763 383 85(O ❑ Insurance—Current: — 50 A__ 1 MECHANICAL SYSTEMSAIING INSTALLED Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. IS THIS GEOTHERMAL? ❑ Yes E4 No HEATING SYSTEMS Quantity: //����/ Make: ��7 Model: -rUoaC,OQ Fuel: GQ5 Flue Size: Input BTUs: IrJOt DDC Output BTUs: -t1 OC 0 CFM: COOLING SYSTEMS Quantity: Make: T � Model: LI 1 )/(co Tons: 9,0 1 H.Power FIREPLACES O 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 O Outdoor Grill ❑ Other/List What&Where: 2 PERMIT FEE CALCULATION(S) s e,, BASED OFF - 2002 STATE STATUE 0 Yes,this section applies The replacement of a Residential fixture or appliance that meets all three of the following requirements: 1. Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excluding 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 Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ w x l4";-1. PERMIT FEE CALCULATION(S —JOBS OVER$500.00 If above does not apply;follow guidelines below: 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) 'a1 x.0125 $ `��'D (contract price) (minimum$50.00) 2. STATE SURCHARGE r \p� D30 . x.0005 $ - d 0 (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ O • * 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. ,� I ;ti; ECHANICAL t n�RMIT APPLICATION AGREEMENT k�^' 1 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 Signa. .re: _ LCeIA., Date: 7 (7 I `) a) 4 Reset Form 3 "1 TOTACOM OP ID:.i A 5 RL CERTIFICATE OF LIABILITY INSURANCE DATE(M20/1YYY) `--� 07/20/12 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 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(f). PRODUCER 763-746-8000 CONTACT RJF Minneapolis PHONE FAX 7225 Northland Dr N#300 (A/C.No.Ext): (A/C,No): Minneapolis,MN 55428 E-MAIL Laura Moore ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Travelers Insurance Co 25658 INSURED A-ABC Appliance&Heating Inc INSURER B:The Builders Group of MN dba Total Comfort 4000 Winnetka Avenue North INSURER C: New Hope,MN 55427 INSURER 0: 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 ADOL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR i(WD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 680009B1967$7 06/01/12 06/01/13 PREM PREAMAGE MISES occurrence) $ 300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 15,000 A X BLKT WAIVER SUB BKLT ADD'L INSURED 06/01/12 06/01/13 PERSONAL&ADV INJURY $ 1,000,000 A X PER LOC AGG 06/01/12 06/01/13 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY X 72,-- LOC PD DEDUCT $ 2,500 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO BA9B196927 06/01/12 06/01/13 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED accident) $ BODILY INJURY(Per AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS _ AUTOS (Per accident) $ , X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 2,000,000 A EXCESS LIAB CLAIMS-MADE CUP000C011117 06/01/12 06/01/13 AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X WC STAT - 0TH- AND EMPLOYERS'LIABILITY Y/N TORY LIMIUTS ER B ANY PROPRIETOR/PARTNER/EXECUTIVEBA9B196927 06/01/12 06/01/13 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? n N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION CTYORON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Orono THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 66 • 2750 Kelley Parkway AUTHORIZED REPRESENTATIVE Crystal Bay,MN 55323 I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD DTE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED —I Z l D PERMIT NO.0?0/0?-O67II/ COMPLETED ADDRESS 10 01(Z CA-94/71-C L-y , s OWNER TELEPHONE NO. 952- V7 3 g617 CONTRACTOR /01-41 CtrYlerd- DESCRIPTION /7E04 C Pi,ia.Z — 7ZI -a ' 4, 0 FOOTING ❑ PLUMBING FINAL 0 EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL • 0 INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q 0 RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS 0 FINAL 0 SEWER HOOK-UP ❑ COMPLAINT v 0 DEMO-SITE 0 SEPTIC MAINT. 0 FOLLOW-UP _ 0 DEMO-FINAL 0 SEPTIC INSTALL 0 HARD COVER REMOVAL 0 PLUMBING RI ❑ SEPTIC FINAL 0 FOUNDATION/REMOVAL OWNER/CONTRACTOR TO MEET YOU:_YES_NO o COMMENTS: CC W O O U- W Q CC W _ W J " d WQ CI .R WORK SATISFACTORY:PROCEED OJECT COMPLETE W ❑CORRECT WORK&PROCEED CIISSUE CERTIFICATE OF OCCUPANCY ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY ✓ BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN CISTOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: u p Ins ector / White Copy/Inspector's File Canary Copy/Site Notice