HomeMy WebLinkAbout2017-00674 - gas line only CITY OF ORONO * 2 0 1 7 — 0 0 6 7 4 *
, 2750 KELLEY PARKWAY DATE ISSUED: 06/20/2017
' ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 880 PARTENWOOD RD
PIN : OS-11'7-23-43-0001
LEGAL DESC : PARTENWOOD
: LOT 006 BLOCK 001
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : GAS LINE ONLY
ACTIVITY : O/S BUILDING-UNDEFINED
VALUATION : $ 500.00
NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION.
GAS LINE ONLY OUTDOOR GRILL
APPLICANT MECHANICAL 50.00
STATE SURCHARGE MECH(VALUATION) 0.25
NYBO-PETERSON CO.INC. TOTAL 50.25
6606 280TH. STREET Payment(s)
MN 55088-
(952)461-2749 CREDIT CARD 8865 50.25
Minnesota State License#:BUIL-058650,cont-MN058650
OWNER
GRAY,JERRY&CYNTHIA
880 PARTENWOOD 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
permits. All provisions of Iaws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if conswction authorized is not
wmmenced 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 confo with the State ildi Code.This permit may be
revoked at any ' e fdr due cause.
��/ V � �
Ap ic Perrnitee Signature Date Issue By gnature Date
FOR C1TY USE ONLY
' /�r City of Orono
f ' �O<yO P.O.Box 66 Date Received: ' pavmf#
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By: Ainount$:
Phone(952)249-4600 Fax(952)249-4616
y��q �.�1� CITY OF ORONO—MECHAIVICAL PERMIT
k�s H�4 (All Commercial pemrits must be appmved by the Building Official or Inspector and/or Fire Ma�shall)
GENERAL INFORMATION
1. You may apply for mechanical pernuts by mail or in person at the City offices. Applications will
be reviewed and a permit will be issued within two working days.
2. Permit cards will be sent by retum mail after a review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Mechanical Desig�s—Complete calculations,details and specifications aze required for each
heating,ventilation,humidification-dehumidification,and air conditioning installarion including
heat loss/heat gain calculation,design temperatures,equipment ratings and identification as to
type,manufacturer and model. Data shall be presented on form provided.
4. When any new construction or remodeling is involved,a separate building permit must be
obtained.
5. All work must be done in accordance with the Uniform Mechanical Code/State Building Code
requirements.
6. All work must be inspected(rough-in and final). Call(952)249-4600.
(24-48 hour notice required)
7. House Heating Test Record must be submitted before final.
TYPE OF PERMIT
Check All That A `1
�Zesidential ❑Commercial(Approval Required) [Backflow Device: ❑AVB ❑PVB]
❑ New �,Addirional ❑Repairs ❑Replace
Job Site/Owner Information:
Site Address: /' C� � �
�►�1 � ��ru�o
Owner�`/�d �Q Mailing Address: �� r'"4/`�w+�.'��,
���: _a��� Zlp: Ss�s 6
Home Phone: 7 s � y7� �t��G Alternate Phone: � �2 �� 7�7
Contractor Tnformation:
Contractor: Yv �'D UC��S� Contact Person:
Address: �� � 2���� State Bond#: �'1��0�� S 3 G
We�s-�� �
City: Zip: /"� Expiration Date: _� ���� /�
Phone: 9�Z"�lZ''��l� Alternate Phone: ��—�!Z—�� 7
❑ Insurance-Current: �(�$(���(,3 �Z ��1 /�
1 �10-�wr�t/' S
/
x e� �,'A�',��,''.S�`��1+�5$�� x. >i ,.���� �;-' � ,;h:
- � .
Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official.
IS THIS GEOTHERMAL? ❑ Yes No
HEATING SYSTEMS
Quantity:
Make:
Model:
Fuel:
Flue Size:
Input BTUs:
Output BTUs:
CFM:
COOLING SYSTEMS
Quantity:
Make:
Model:
Tons: �
H.Power
FIREPLACES
❑ Gas Fac�ory T�replace, p � , . . • Brand Name: � �`
♦ � �r
❑ Wood"Burrung Fireplace �
❑ .. Wood Stove Model Nq.:
'r``'°" � ❑ 'Wood Stove with Flue/Masonry . ' ' • � �� - '
y .��, . t�;
,
`F
VENTILATION � , w
�_ No. Kitchen Exhaust .duct recirculating cfin
� ��.'` � + �� ^No.` � Bath Exhaust(must hav�duct oittsid��+ � +► '' � cfin
❑ No. Other Fans: Locations ��
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 Cmll ❑ Other/List What&Where:
2
/ ' T��i��T�;�£,',4�,." ��'`;P � �.�°-��'f
,� � ,�.
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00)
���• �Q x.0125$
(conhact price) (minimum$50.011)
2. STATESURCHARGE
x.0005 $
(contract 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 chazged for the
permitted work including materials, labor,profit,and other fixed costs. It is the amount to be char�ged
to the customer for the work done. If any material,equipment,labor or installations are fumished 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.
.��..���,�.„��-a��� -
���h^r
The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all
work in strict accordance with the ordi ces of the City and the regulations of the State of
Minnesota,and certifies that all state nts ade on this application are complete,true and correct.
Applicant's Signature: Date: ,(,7 2 �—��� �
3