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HomeMy WebLinkAbout2018-00474 - mechanical • - CITY OF ORONO I 1' 11 I 11 * 20 1 8 - 00474 * 2750 KELLEY PARKWAY DATE ISSUED: 04/18/2018 ORONO,MN 55356- (952)249-4600 FAX: (952) 249-4616 ADDRESS : 2625 KELLY AVE PIN : 20-117-23-14-0026 LEGAL DESC : TOWNSITE OF LANGDON PARK : LOT 000 BLOCK 005 PERMIT TYPE : MECHANICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : MECHANICAL-MULTIPLE VALUATION : $ 125,138.00 NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. (1)BRYANT HEATING SYSTEM-MODEL 987MA66100 (1)BRYANT HEATING SYSTEM-MODEL 987MA42080 (1)BRYANT HEATING SYSTEM-MODEL 987MA42050 (1)NTI BOILER-MODEL TFT85 (3)BRYANT COOLING SYSTEMS-5 TON,3 TON,2 TON (1)KITCHEN EXHAUST- 1200 CFM GASLINE FOR 2 DRYERS,3 FIREPLACES, 1 RANGE,3 FURNACES,2 BOILERS AND 1 GENERATOR APPLICANT MECHANICAL 1,564.23 HORIZON CONTRACTORS. STATE SURCHARGE MECH(VALUATION) 62.57 8197 HORIZON DR MAIL-IN FEE 2.00 SHAKOPEE,MN 55379 TOTAL 1,628.80 (612)508-9226 Payment(s) Minnesota State License#:mech-MB42235 CREDIT CARD 3758 1,628.80 OWNER ELLEN REDMOND REVOC TRUST 2625 KELLY AVE EXCELSIOR,MN 55331- 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. 614,1110 14:1550 1// 15/ / Applicant Permitee Signature Date Issue y ignature Date , 1TY VSE City of Orono Rec �61 {J P O'G ?' / 7/ �+OO PO.Box 66 Date 2750 Kelley Parkway i Crystal Bay,MN 55323 Approved By: Amount$: /J 47 ,?. Phone(952)249-4600 Fax(952)249-4616 `�rqj CITYOFORONO-MECHANICALPERMITkEs (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) [Backflow Device:0 AVB 0 PVB] New 0 Additional 0 Repairs 0 Replace Job Site/Owner Information: Site Address: cue 5 )CeJ L( Owner: P.P.,i/vvorici2 Mailing Address: SeeAL- City: VfOYNO Zip: • S35-.33 Home Phone: f 5)-i35--q WO Alternate Phone: Contractor Information: Contractor: t-i Z.:cr C(+yrt ) - ,rc5 Contact Person: 1 L.& Address: S Pit R-)N torAr State Bond#: i031 City: ... 440 _a..v_ Zip:5-5-37q Expiration Date: ____ a C Phone: ‘1,/--SW," "i D .(.,, Alternate Phone: (:/-m'5- -9gaq ❑ Insurance-Current: 1 lwt Atiia*s ,:,OZ * /�� .013 .dr xcw ii Note:AU Geothermal Systems will now require a Site Plan&Review by our Building Official. IS THIS GEOTHERMAL? ❑Yes gNo HEATING SYSTEMS Quantity: I / I Make: EY'.E irt+ a Com(t.1 k4 6 f t%u? /1,/ " Model: 918.')PI1 t / 12 Rvilao To II)n /W*1 0 7F-1- Fuel: TFuel: /Oat,/ /(!ak4c < APU recce Air 6,,r Flue Size: .34 s_ .Q QCT 3$S-e,a4P. f)iisegtid, Input BTUs: /60ra..9 O,&OO 64660 S( (9- Output BTUs: 1tSrGC)0 '7grC1Gtt7 al/aOa Slit.900pp� jj� _� CFM: /&'5 1139 .J 1 r a NA169,t,3tt'": COOLING SYSTEMS Quantity: t Make: Bftlf{ -rip.rA 6 e yea- Model: 18q6 Jo V©4 J) / 't Q I•I UO3 / '1 8Nuoail Tons: - H.Power FIREPLACES ❑ Gas Factory Fireplace Brand Name: ❑ Wood Burning Fireplace ❑ Wood Stove Model No.: ❑ Wood Stove with Flue I Masonry VENTILATION No. / Kitchen Exhaust_ / duct , recirculating /6114)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.) 0 Installation ❑ Removal Fuel Oil: gallons 0 Underground 0 Inside 0 Outside LP Gas: gallons Other: GAS LINE ONLY Outdoor Grill 14 Other/List What&Where: - (1 er - S'-t regi a c.¢,r, 1- 47*.1445--12' 2 PERMIT FEE CALCULATIONS 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) L , /)8 - x.0125$ (contract price) (minimum$50.00) 2. STATE SURCHARGE 1.25',13 g - x.0005 $ (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ / "O Er() • * 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: ' Date:, U 3 DEPARTMENT OF III LABOR AND INDUSTRY License/Certificate/Registration Detail Class Type: CONTRACTOR REGISTRATION Number: 1R739455 Application No: 416340 Status: ISSUED Expire Date: 12/31/2019 Effect Date:4/11/2018 Orig Date: 4/11/2018 Print Date: Enforcement NO Action: Workplace N/A Experience: Name: TRHORIZON GROUP, INC. DBA HORIZON CONTRACTORS Address: 8105 JEFFERY LN SO COTTAGE GROVE , MN 55016 Phone: Fax: Other: A CONTRACTOR REGISTRATION IS NOT A LICENSE! Contractor Registration is required for building contractors that are not licensed or required to be licensed by DU, but it is not ini any level of consumer protection.To verify the status of licensed residential contractors, remodelers,and roofers,search and Contractors"Discipline"on the license lookup tool Another Lookup? Central Region Western Region 4700 West 77th Street 10851 N.Black Canyon Highway Suite 630 WESTERN NATIONAL Edina,MN 55435 Phoenix,AZ 85029 ixsuttascs (800)862-6070 (855)283-8106 The relationship company BOND EXECUTION REPORT AGENCY: PRINCIPAL: INNOVATIVE INSURANCE SVCS TRHorizon Group Inc 8001 Old Carriage Court N,Suite B 8105 Jeffery Lane South SHAKOPEE,MN 55379 Cottage Grove,MN 55016 OBLIGEE: SURETY: Minnesota Department of Labor and Industry-Construction Western National Mutual Insurance Company P.O.Box 64227 4700 W.77th St. St.Paul,MN 55164-0227 Edina,MN 55435 BOND INFORMATION: Bond Number: 42235 Type of Bond: Mechanical Contractor Bond 12/11 Date of Execution: 03/21/2018 Class Code: 909 Effective Date: 03/21/2018 Expiration Date: 03212020 Penal Sum: $25,000.00 State: Minnesota Premium: $219.00 Billing Method: D (8=Agency BM,0=Direct BIM NOTES: Western National appreciates your business! The first year premium is fully earned on the issuance of this bond. The premium will be billed according to the billing method listed above: Direct Bill Payments- Bill Pay: (800)352-2772 -Payment can be made on-line or by mail to: Western National Insurance Group -P.O.Box 59184 Minneapolis,MN 55459-0184. Agency Bill- Statements are mailed monthly to the agency with net amount due for the total statement. • 4/18/201`8 Horizon Contractors Mail-Fwd:LABOR AND INDUSTRY-INITIAL APPLICATION INFORMATION at 1 Michael Stang<mike@horizoncontractors.us> Fwd: LABOR AND INDUSTRY - INITIAL APPLICATION INFORMATION 1 message Todd Hatlestad<todd@horizoncontractors.us> Thu,Apr 12,2018 at 10:07 AM To: Michael Stang<mike@horizoncontractors.us> --------Forwarded message From: <noreply@state.mn.us> Date:Wed,Apr 11,2018,4:55 PM Subject:LABOR AND INDUSTRY-INITIAL APPLICATION INFORMATION To:<todd@horizoncontractors.us> Thank you for submitting your application to the Minnesota Department of Labor and Industry Construction Codes and Licensing Division(CCLD). TRHORIZON GROUP, INC. INITIAL APPLICATION FOR: MECHANICAL CONTRACTOR BOND APPLICATION#:416341 If you submitted a registration as part of the new contractor registration pilot program,please pay no mind to the rest of this message as you need not take further action unless contacted by CCLD staff for additional information. Questions about the registration pilot program should be directed to(651)284-5074. All other applicants: please be sure to include your application number on any correspondence or additional documents you submit to the Department. If any required documentation was not electronically submitted during the initial application process,please submit via U.S. Mail to: MN Department of Labor and Industry CCLD Licensing and Certification 443 Lafayette Rd N St Paul, MN 55155 You will be notified by CCLD staff if there are any deficiencies in your application submission. Questions may be directed to CCLD Licensing staff by: at(651)284-5031 for Individual/Personal licenses or(651)284-5034 for Company/Contractor licenses,toll free at 1-800-657-3944;TTY at(651)297-4198;or email at dli.license@state.mn.us. Sincerely, Minnesota Department of Labor and Industry Construction Codes and Licensing Division(CCLD) https://mail.google.conUmait/u/O/7ui=2&ik=6790dbb71a&jsver=OniOzc dHkxc.en.&view=pt&cat=Todd%20Horizon&search=cat&th=162ba68d08e40e67&sim1=162ba Minnesota Department of Labor and Industry CCLD-Licensing and Certification Services PO Box 64220 Mechanical Bond 1111111 St. Paul,MN 55164-0220 Phone: (651)284-5034 Fax: (651)284-5743 CC0516 E-mail: DLI.License;!state.mn.us BOND NO. AMOUNT EFFECTIVE DATE ENDING DATE www.dli.mn.gov 42235 $25,000 PRINT IN INK or TYPE March 21,2018 March 21, 2020 KNOW ALL MEN BY THESE PRESENTS: THAT TRHorizon Group Inc (Business name as Registered with the Office of the Minnesota Secretary of State;or if individual sole proprietor,individual's name.) (DBA,doing business as name if applicable) With business office at 8105 Jeffery Lane South Cottage Grove, MN 55016 (651)285-9824 (Business Address City State Zip Code Telephone number) as PRINCIPAL,and Western National Mutual Insurance Company (Surety Company Name) 4700 W.77th St. Edina,MN 55435 (952)835-5350 (Surety Company Address City State Zip Code Telephone number) A corporation duly organized in the state of Minnesota and authorized to do business in the state of Minnesota, as Surety, are jointly and severally held and firmly bound to the state of Minnesota as obligee, in the sum of TWENTY-FIVE THOUSAND DOLLARS ($25,000) for the benefit of persons injured or suffering financial loss by reason of failure of such performance as herein specified for the payment of which, we bind ourselves, our heirs, executors, administrators, successors and assigns firmly by these presents. The bond shall be filed with the Minnesota Department of Labor and Industry and shall be in lieu of all other license bonds to any other political subdivision. NOW THEREFORE, the condition of this obligation is such that WHEREAS the said Principal has contracted to do gas, heating,ventilation,cooling,sir conditioning,fuel burning,or refrigeration work within the state of Minnesota,then the Principal shall faithfully and lawfully comply with the Minnesota State Mechanical Code(Minnesota Rules, Chapter 1346)as provided in Minnesota Statute 326B.197 when performing work in the state of Minnesota and indemnify any person dealing or transacting business with the Principal from any financial loss or damage occasioned by the failure of the Principal to comply with any requirements of Minnesota Rules, Chapter 1346, then no obligation under this bond shall accrue; otherwise this bond shall remain in full force and effect. During the term of this obligation the Principal and Surety will pay unto the persons injured or suffering financial loss the amount needed to correct non-complying work. The aggregate liability of the Surety hereunder pertains to all claims, regardless of the number of claims made against the bond or the number of years the bond remains in force,shall in no event exceed the total sum of TWENTY-FIVE THOUSAND DOLLARS($25,000). The bond may be cancelled by the Surety, as to future liability, by giving written notice by Certified Mail, addressed to the Principal at the address as stated in the bond, and to the Department of Labor and Industry, Construction Codes and Licensing Division, 443 Lafayette Road No., St. Paul, MN 55155. Thirty(30) days after the mailing of that notice,this bond shall be null and void as to any liability thereafter arising, the Surety remaining liable, however, subject to all the terms, conditions, and provisions of this bond,for any and all acts covered by this bond up to the date of the cancellation.The Surety shall notify the Principal and the Department of Labor and Industry if it has made any payments on the bond which result in the value of the bond falling below the minimum amount required by law. "".••.... Signed and sealed this 21st day of March 2018 i c3' rR`gys (SURETY SEAL) SEAL: TRHorizon Group Inc ! "•••..*,..•.• Print Name of Principal(s) SIGNATURE OF PRINCIPAL(S) Todd Hatlestad Print Name of Principal(s) SIGNATURE OF PRINCIPAL(S) Wes -m National Mutual Insurance Company Acknowledge(notarize)signatures on reverse side and attach NAME OF -g-:"t power of attorney form. i //__"a/1f File with: Minnesota Department of Labor and Industry SIGNATUREOF ATTORN IN FACT(SURETY COMPANY) CCLD—Licensing and Certification ( 443 Lafayette Road N Dan Williams St.Paul,Minnesota 55155 CC0516 Mechanical Bond(12/11) A OR B AND C MUST BE COMPLETED TRHorizon Group Inc 42235 A. FOR ACKNOWLEDGEMENT OF Individual,Partnership,Limited Liability Company or Limited Liability Partnership (Note: If partnership all signatures required to be notarized.Please copy the page if necessary.) STATE OF ) )ss COUNTY OF ) On this day of personally came to me well known to be the identical person(s)described in and who executed the foregoing bond and he/she/they acknowledged the same to be his/her/their own free act and deed. (SEAL) Notary Public, County, My Commission Expires B. FOR ACKNOWLEDGEM ENT of Corporate Contractor STATE OF ON.t1t1�4a cx ) COUNTY OF to. )ss } On this 20* day of `AO...c& , 'Mit) personally came Tbdd e.S ck.c,� who being by me duly sworn,did say that he/she is Pc'►n�.�a�1 of TRAltir3r','t.on (,.rant tr.c. ,a IN‘',fwv2.&64 .,. corporation;and that said instrument was executed in behalf of the corporation by authority of its Board of Directors;that he/she acknowledged said instrument to be the free act and deed of the corporation. (SEAL) SARAJEANNEQUALE1114V0./ NOTARY PtkiUC•MINNESOTA Notary Public ounty, CpulJP. "' My Commission Expires Jan.31,2023 war��_-c 2 rr✓� ✓rrrr ��J� My Commission Expires 0 12-02-21 PART C MUST BE COMPLETED BY THE SURETY COMPANY C. FOR ACKNOWLEDGEMENT of Corporate Surety STATE OF +hRe.s64-O.. ) )ss COUNTY OF ' stro_„r ) On this 2-\S'CkeUJ cc Cr1a.tcCh 7-01j personally came Dan Williams and Dan Williams to me personally known,who being by me duly sworn,did say that he/she is the attorney in fact,of Western National Mutual Insurance Company ,the corporation whose name is affixed to the foregoing instrument;that the seal affixed to the foregoing instrument is the corporate seal of the said corporation;and that said instrument was executed in behalf of said corporation by authority of its board of directors and said Dan Williams acknowledged that he/she executed said instrument as attorney in fact as the free act and deed of said corporation. a`pNFn MyrG Z r ,c,,rFtN ` NOSTARY RA=IC--MINNESOTA 2Y. Notary Public, • � ' aunty, ��kli1J(� SEAL i t l My Commission EA"S9'131.2°23 t1 My Commission Expires n 1311202.24 ; '•41vEsolt s WNATERN NATIONAL 'r YliK4kr:M 7114 r14011014mammy POWER OF ATTORNEY • KNOW ALL MEN BY THESE PRESENTS: That Western National Mutual Insurance Company, a Minnesota mutual insurance company, does make,constitute and appoint Dan Williams INNOVATIVE INSURANCE SVCS Its true and lawful Attomey(s)-in-Fact, with full power and authority for and on behalf of the Company as surety,to execute and deliver and affix the seal of the Company thereto(if a seal is required)bond,undertakings recognizances or other written obligations in the nature thereof,(other than ball bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and note guaranty bonds, self-Insurance workers compensation bonds guaranteeing payment of benefits, hazardous waste remediation bonds or black lung bonds),as follows: All written instruments in an amount not to exceed an aggregate of Twenty Five Thousand Dollars($25,000.00) for any single obligation,regardless of the number of instruments issued for the obligation. and to bind Western National Mutual Insurance Company thereby, and all of the acts of said Attorneys-in-Fact, pursuant to these presents, are ratified and confirmed.This appointment is made under and by authority of the board of directors at a meeting held on September 28,2010. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of Western National Mutual Insurance Company on September 28,2010: RESOLVED that the president,any vice president,or assistant vice president in conjunction with the secretary or any assistant secretary, may appoint attorneys-in-fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case,for and on behalf of the company to execute and deliver and affix the seal of the Company to bonds, undertakings, recognizances, and suretyship obligations of all kinds, and said officers may remove any such attorney-in-fact or agent and revoke any Power of Attorney previously granted to such person. RESOLVED FURTHER that any bond,undertaking,recognizance,or suretyship obligation shall be valid and binding upon the Company (i) when signed by the president, any vice president or assistant vice president,and attested and sealed(if a seal be required)by any secretary or assistant secretary;or (ii) when signed by the president,any vice president or assistant vice president,secretary or assistant secretary,and countersigned and sealed(if a seal be required)by a duly authorized attorney-in-fact or agent;or (iii) when duly executed and sealed(if a seal be required)by one or more attorneys-in-fact or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney issued by the Company to such person or persons. RESOLVED FURTHER that the signature of any authorized officered the seal of the company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company;and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF,Western National Mutual Insurance Company has caused these presents to be signed by its proper officer and its corporate seal to be affixed this 16th day of December ,2015. w 41;.- T l �'e 1 SEAI.�j }` c Jon R.Hebeisen,Secretary Larry A.Byers,Sr.Vice President STATE OF MINNESOTA,COUNTY OF DAKOTA On this 16th day of December. 2015, personally came before me,Jon R.Hebeisen and Larry A.Byers and to me known to be the individuals and officers of the Western National Mutual Insurance Company who executed the above instrument,and they each acknowledged the execution of the same,and being by me duly sworn,did severally dispose and say;that they are the said officers of the corporation aforesaid,and that the seal affixed to the above instrument is the seal of the corporation,and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation. JENNIFER A Y( ti 9-#""i4-) `-' 4` NOTARYFt18tle•META COMMMY ON 0141/2021 Jennifer A.Young,Notary Public EXPIES My commission expires January 312021 CERTIFICATE I,the undersigned,assistant secretary of the Western National Mutual Insurance Company,a Minnesota corporation,CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked;and furthermore,that the Resolutions of the board of directors set forth in the Power of Attorney,are now in force. c2,014-rse/ (,�fJ, i(SEALI � P dil"r Signed and sealed at the City of Edina,MN on 03/21/2018 Jennifer A.Young,Assistant Secretary