HomeMy WebLinkAbout1985-7819 - nat gas furnace GENERAL PERMIT CITY PERMIT NO. 7819
CITY OF ORONO � es—
CRYSTAL
66 Date
CRYSTAL BAY,MINNESOTA 55323
Ale-We
(612)473-7357 ,/J
Owner � J e-We J/ �Ji2 fC_Sd Address /3 8-5- -z n-nn GZ/IL;Q
Contractor/vO,rl 7fi 2 . Address -71/0 eV L,Jel-Sktrt9 ,>i ('•
City License No. 4tc,70 State License No. -Pmc.t-4_,0
REMARKS AND SPECIAL CONDITIONS
Fina() - mai .
PERMIT TYPE AND FEE: 0 NEW ❑ ADDITION 0 REPAIR
Inside Plumbing(#fixtures_) Fee $ Water Well Fee $
Water Meter(Size_) Fee $ Mechanical Equipment Fee $o25--0 d
Meter#
Remote# Moving/Lifting Buildings Fee $
Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $
❑Copper
n Grading, Filling, etc.)
Municipal Sewer Connection Fee $
Fire Fee $
0 PVC 0 Cast n Sprinkler System (Fire) Fee $ ,1
MWCC SAC Charge Fee $ Other %' - ! Fee $ Ii 3—U
On Site Septic System Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information,
terms, conditions or requirements written above. The /1
undersigned understands and agrees under penalty of law State Surcharge: Fee $ " SV
that this permit is strictly limited in scope to the work,
activity or improvement specified; that this permit does pl--7 °O T
O
not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ C /
separate permit approvals; and that this permit does not
grant authority to violate any provision of any City
ordinance or State law,rule or regulation.All work shall be
done in strict compliance with all City ordinances,building
codes and/or health department regulations, and shall be This permit is not valid until the proper fee is paid and
subject to inspection, approval or rejection by the City. it is approved byauthorized CityOfficial.
Whenever so ordered, the undersigned agrees to correct pp an
any work found to be in violation of the conditions of
this permit.
Signature of Applicant Signat re of City fficial
€"frkj
Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt
CITY OF ORONO
APPLICATION FOR MECHANICAL PERMIT
GENERAL INFORMATION
1 . You may apply for mechanical permits by mail or in person at the City
offices. Mailed-in permits are subject to the postage and handling
fees shown below.
2 . Permit cards will be sent by return mail the same day the application
is received. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK
MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE.
3 . When any new construction or remodeling is involved, a separate
building permit must be obtained.
4. All work must be done in accordance with State Building Code
requirements.
5. All work must be inspected (rough-in and final). Call 473-7357. 24-
hour notice required.
6. House Heating Test Record must be submitted before final.
INSTRUCTIONS Complete all items on this application. Compute the permit
fee. Sign and date the certification. INCOMPLETE APPLICATIONS WILL NOT BE
PROCESSED. If you have questions, call 473-7357.
WALK-IN PERMITS apply at City Offices, 1335 South Brown Road (Cty. Rd 146)
MAIL-IN PERMITS enclose fee - Mail to: P.O. Box 66, Crystal Bay, MN 55323
***************************************************************************
JOB SITE 11cp.s' 4, -- o- ,�
Owner ' s Name _ j Telephone Number
Mailing Address /le- _ ,
Contractor ' s Name , . -L Telephone um1 ea J-Id
Mailing Address 7 Qin �°
*********************T**** * *f=***** *;*****************4******* ***
MINIMUM FEE ( $25. 00 per project)
***************************************************************************
HEATING SYSTEMS $20. 00 each unit
FUEL X nat. gas, ip gas, oil, elect.
other (specify if combination burner)
EQUIP. (if more than 1 unit per bldg. list each separately)
NO. TYPE BTUH IMPUT BRAND NAME MODEL NO.
_J_- f.a. furnace �r�,r,,,,,6,-48 ,v 4/oo 44-93
hw boiler
unit heater
solar htg.
equipment
Solar Equipment $50.00 each system Total* 00
************************************************************ *************
AIR CONDITIONING $20. 00 each unit
Central Air Separate Central Air System
w/furnace
Brand name Model No. Tons
Total
***************************************************************************
*WOOD BURNING EQUIPMENT No charge Wood stove with flue
No charge Wood combination or add-on unit
$30. 00 each unit Factory fireplace with flue
Factor Fireplace (s ) freestanding built-in
Wood Stove (s ) franklin, other
Brand Name Model No.
Mfgr ' s Min. , Clearances , side , rear , min. flue dia.
Total
*******************************k*******AA**********************************
VENTILATION $5. 00 each exhaust fans, (bath, kitchen,
attic, etc. )
No. Kitchen Exhaust ducted recirculating cfm
No. Bath Exhaust (must be ducted outside ) cfm
No. Other Fans : Locations cfm
Total
***************************************************************************
FUEL STORAGE (must be approved by fire marshal ) $20 . 00 Permanent
$10. 00 Temporary
Fuel oil, gallons underground inside outside
LP Gas, gallons
Other
***************************************************************************
SPRINKLER SYSTEMS Minimum $20 . 00 each system
Number of Heads No. of Risers $2 . 00 per head
***************************************************************************
PERMIT FEE CALCULATION
1 . Total of above Installations or Minimum Fee ( $25. 00 ) $
2 . State Surcharge. Add the State Building Code Division
Surcharge to each permit $ . 50
3 . Postage and Handling on all mailed-in applications , $ 1 . 50
4 . TOTAL PERMIT FEE add lines 1-3 above $
The undersigned hereby applies to the City of issuance of a Mechanical
Permit, agrees to do all work in strict accordance with the ordinances of
the City and the regulations of the Minnesota State Building Code, and
certifies that all statements made on this application are complete, true
and correct.
Applicant , L / /` ,�_ / Date 01 -/2-
* WOOD BURNING STO ' ES Please note that there is no longer a fee for
wood burning stove permits. We do however still require a permit to
be issued. If the permit application is mailed in we do require a
$1.50 charge for postage and handling.
11111 .
, HOUSE HEATING TEST RECORD
ADDRESS ,'' `2,?-5.- Q �` APT. FLOOR CITY SUBURB
OCCUPAN _
' OWNER
HEAT LOSt ' D.S.TE HTG. INST.
SOLD BY INSTALLED BY
Electrical Werk By l^.. Y Gas Line By
TYPE OF HEAT SGA FA NW STEAM___!`SPACE HTR. UNIT HTR. OTHER
GAS,D IGN A CONVERS
MAKE MAKE OF BURNER
Model 0-0 I/ 3 3 Model 'y 0-0 /V '3
Serial ..."NO S !> / 0-O O-O (?'v-0
`�i Max. BTU Rating T /
INPUT 'ya9-m 4-0-0 MAKE OF FURNACE Pan/...A5s
Model . '1NK,.Ow .d
CONTROLS
THERMOSTAT? O /0
~
Heat Plug Vent Size
Valve_HO Vm r 6A-4o'TRot KIND OF LINER 7744- SIZE/o X/4 NONE
Limit f/D'✓i.Y1411:"/-1-- Draft Hood! C Regulator AI 4X/TR 01-..
Limit Setting . 5 _ Filters Size A/6 ^fes Number ''''''
Fon Setting /1/0A-14? Chimney Location Inside X Outside
Pilot Type 4'I e_TRts.'t i= Chimney Construction 81 /c•K ¢ Tl i L'
Pilot Make' O U w/ZAL
Pilot Model All 54O /C Smoke Bomb . N0 L 6 4' Wiring u K
Pilot Timing S�C' Draft s 0 al Test Tog AT74-a4/f 17
L.W. Cut Off K Door Pressure A1-0414 Lighting� Inst. Ql'g'!0 F
Pressure 3,�'�/ Percent ' 8. o Dote Tested ._ if 2 r / - 8-T
CO2tn
Input CFH Oh 44471" Percent 02 Company Testing n
Stock Temp. 4/SO Percent CO 'ONG Name of Tester K 4--1"-'��'---