HomeMy WebLinkAbout2016-00867 - mechanical CITY OF ORONO * 2 0 1 6 — a 0 e 6 7 *
L , 2750 KELLEY PARKWAY DATE ISSUED: 07/25/2016
ORONO,MN 55356-
952)249-4600 FAX: (952) 249-4616
ADDRESS : 500 OXFORD RD
PIN : OS-117-23-41-0015
LEGAL DESC : STIELOWS ADDN
: LOT 007 BLOCK 001
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : COOLING SYSTEMS
VALUATION : $ 3,500.00
NOTE: REPLACE A/C
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 1.75
AIRICS HEATING LLC MAIL-IN FEE �.00
2609 HWY 13 W
BURNSVILLE,MN 55337- TOTAL 53.75
(952)345-0032 Payment(s)
Minnesota State License#:mech-MB004088 CHECK 16286 53.75
OW1�iER
NELSON,ALBIN&SUSAN
500 OXFORD 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 dces
not grant permission for additional or related work which requires separate
pertniu. 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 Date Issu ignature Date
F R SE ONLY
�O A? City of Orono p�7
<y P.o.Box 66 Date Receiv«i: �t#���� a
� O 2750 Kelley Parkwa�ECE1VE�
c�r�say,MN 55323 A�ovea sy: Amount s:`
Phone(952)249-4600�(�2�2�t1G�6
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11kESH0��G CI��f� MECHANICAL PERNIIT
(All Commercial perrcvts must�by the Building Official or Inspector and/or Fire Marshall)
c�rrrE�r,nvFo��oN
1. You may apply for mechanical permits by mail or in person at the Ciry 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 UNTII.YOU RECENE A PERMIT. WORK MUST NOT BEGIN UNTIL TIiE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical Desi s—Complete calculations,details and specifications are required for each
heating,ventilation,humidificarion-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 Hearing Test Record must be submitted before final.
TYPE OF PERMIT
Check AlI That A` ' 1
�Residential ❑Commercial(Approval Required) [Backflow Device: ❑AVB ❑PVB]
❑New ❑Additional ❑Repairs �Replace
Job Site/Owner Infarmation:
Site Address:
Owner: >�h �,��u Y 1 Mailing Address: � �
��Ty: �]C�.�.b Z�p: 55�`p
Home Phone: ��1�7i 1�'�Q �� Alternate Phone:
Contractor Information:
Contractor: �, Contact Person: �ma nd
Address: `d��� State Bond#: �
City: Zip�1 Expiration Date:
Phone: i �� Alternate Phone: � �
❑ Insurance—Current: � QiS �-
1 �
Note:All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS TffiS GEOTHERMAL? ❑Yes �No
�
AEATING SYSTEMS
Quantiry:
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Q�nty; �
Make: ��'U�L��_1_!L_—
Model: ������
Tons:
H.Power
FIREPLACES
❑ Gas Factory Fireplace Brand Name:
❑ Wood Burning Fireplace
❑ Wood Stove Model No.:
❑ Wood Stove with Flue/Masonry
VENTII.ATION
❑ No. Kitchen Exhaust duct recirculating cfm
❑ No. Bath Eachaust(must have duct outside) cfin
❑ No. Other Fans: Locations cfm
FUEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in plac�)
❑ Installation ❑ Removal
Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside
LP Gas: gallons
Other:
GAS LINE ONLY
❑ Outdoor Grill ❑ Other/List What&Where:
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1. CONTRACT PRICE ' is 1.25%of contract price with a(Minimum Fee of$50.00)
.���. �� x.0125$ � .oa
�
(conpact price) (minimum 550.00)
2. STATE SURCHARGE � Gj O x.0005 $ I •��
✓
(coatract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $_���
• * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
permitted work includ'mg 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 aze 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 pernut 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.
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 t at eme ts made on this application are complete,true and correct.
ApplicanYs Signa e: Date:
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