HomeMy WebLinkAboutlawn sprinkler info/various addresses ,
� `"��" City of Orono ��. ���� FO C Y USE ONLY
�' ¢ � P.O.Box 66 �(/
��� _ ���� z�so Keuey pa�k.,�ay ��' // � /�--� �(�/ 2— '!/02�
Date Received: Permit tt
� �`� �'= �� Crystal Bay,MN 55323
��, �.t�;�, �':',
� <�,?�r��� Phone:(952)249-4600 Fa�c: (952)249-4616 Approved By: Amount$:
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CITY OF ORONO—LAWN SPRINKLER PERMIT
PERMIT CODES(IN-HOUSE)
Sprinkler/Residential/Lawn Spnnkler/Blank
Spnnkler/Residential/Backflow Device OnlyBlank
Please Check One: New Addition❑
Job Site Address: ��� ' �- 1� � .5��� ,
Owner: �� c��- �� ' l,,��/�` � Telephone Number: ���_� � ��� ��/
Mailing Address: _ )�� ___1� P� �
� �
City: ' L Zip: `7� �D�
�I�l% r Contractor: � o"�, OC � � N'�/���elephone Number:�l�- ���5��
���a�C-�e � ' �
Contact Person : '/L License#:
Mailing Address:
) - �� , � �
WATER SUPPLY
Lake ❑ Well ❑ City ❑
BACKFLOW DEVICE
AVB ❑ PVB ❑ ��
�---� ,
Make ,, �(� Model � Year of Manufacture Quantity
Sprinklers:
HYDRAULIC CALCULATIONS Design Data:
Area of Application: Sq. Ft.
Coverage per Sprinkler: Sq. Ft.
No. of Sprinklers:
Tetal Water Requi:ed: GPM
PERMIT FEE CALCULATION
1. Permit Fee: $ 50.00
2. State Surcharge $ 5.00
3. Mail-In Fee $ 2.00
4. TOTAL PERMIT FEE(Add lines 1-3 above) $�(�
The undersigned hereby applies to the City of issuance of a Sprinkler System Permit, agrees to
do all work in strict accordance with the ordinances of the City and State regulations, and
certifies that all statements made on this application are complete, true and correct.
Applicant Date
..............................................................................................................................................................................................................................
Approved Approved with Corrections Denied
Reviewed By: Date
Reset Form
CITY OF ORONO
APPLICATION FOR LAWN SPRINKLER SYSTEM PERMIT
GENERAL INFORMATION
1. You may apply for sprinkler system permits by mail (P.O. Box 66, Crystal Bay,MN
55323)or in person at the City offices(2750 Kelley Parkway). Submit plans for review
with this application.
2. PERMITS ARE NOT VALID UNTIL YOU RECENE A PERMIT. WORK MUST
NOT BEG1N 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 City and State Building Code requirements.
5. Two (2) sets of working plans shall be submitted for approval to the authority having
jurisdiction before any equipment is installed or remodeled. Deviation from approved
plans will require permission of the authority having jurisdiction.
Workin�plans shall be drawn to an indicated scale on sheets of uniform size with a plan
of the site so that they can easily be duplicated and shall show the following data: �
a. Name of owner and occupant
b. Location, including street address
c. Point of compass
d. Location of septic system if applicable
e. Source of water supply
f. Pipe size
g. Pipe location
h. All control valves,check valves, drainpipes
i. Name and address of contractor
6. All work must be inspected(final). Call (952)249-4600.24 to 48 Hour Notice
Required
INSTRUCTIONS Complete all items on this application. Incomplete applications will not be
processed. If you have questions, call (952)249-4600. You will be notified by phone when the
permit review is complete.
�v�V
E�IA�{J.Fyn4POLIS, REGUI����',;�F,�V,�CES
J �E3'FIOM3IIIVISION'.:;�;'�`�
__^ 250�G�Stifi#a+4u'=Str�et Roorr��00
:...
-`---.�_..�_ � �inneapo#P��IVIN '�54T5-13'F�
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', ww�.ci:lrii�u�eapotis4rnmustmd r
���:�-��
BACKFLOW PREVENTOR (RPZ) TEST REPORT
JOB ADDRESS: "��1� � �f � �
��
OWNER/OCCUPANT/CONTACT PERSON• � � _ CONTACT PHONE: �_ ��� _�--7��
/
DEVICE LOCATION: �Ju�. �,��. l , � � FLOOR#: ROOM#:
SERVES WHAT SYSTEM: ��,-/,-
�� ��
r
MAKE: MODEL#: �� � SIZE: � SERIAL#: :�O
!%
INSTALL DATE(MONTH/DAY/YEAR): OVERHAUL DATE(MONTH/DAY/YEAR): TEST DATE(MONTH/DAY/YEAR):
+� � j �� (DO NOT PUT A FUTURE DATE IN THIS BOX) /� /�� ��
� ! J
#1 CHECK VALVE RELIEF #2 CHECK VALVE
PSI/DIFF PSI/DIFF
TEST BEFORE REPAIRS
FINAL TEST � � �� � /���
t
DE$GRlSE REPAIR IF ANY(IF T!iIS 15 A�dE:N lkSTA�LATION AND REoLAC�S A�v�XIST:PIG DEl'ICE,INCICATE THE SERIAL NUM$ER
OF THE DEVICE REMOVED):
� `
TEST DONE BY(PLEASE PRINT FIRST 8�LAST NAME):
CI�� � CERTIFICATION NUMBER: � ^��� i��
f� J l
COMPANY NAME: (� � MPLS CONTRACTOR LICENSE#: OI�J (/U
COMPANY ADDRESS: s, COMPANY PHONE#: �� - �
�n��� /
CITY: ( STATE: V 1'(OJ ZIP: 7 �' CONTACT PERSONlPHONE#: ,
ATTACH THIS COMPLETED TEST REPORT TO PLUMBING/GASFITTING/RPZ PERMIT APPLICATION P�ND
SUBMIT WITH FEE
7/30l2007
�� � City of Orono � ��� FO CIT USE OhLY
� Qb .t'�t.
{„�� a'.; P.O.Box 66 �A/ �1
�� � 4� 2750 Kelley Parkway //��VV Date Received/� � rmit# �!/� � �
'i � �" � ��� Crystal Bay,MN 55323 v
t�� �6"�r�'�i^���� Phone: 952 249-4600 Fax: 952 249-4616
��` ���, ��/i � ) ( ) Approved By: Amount$:
.�zatic.,:�
CITY OF ORONO–LAWN SPRINKLER PERMIT
PERMIT CODES(IN-HOUSE)
Spnnkler/Residential/Lawn Sprinkler/Blank
Spnnkler�Resideotia]/Backflow Device OnlyBlank
�'lease Cheek One: New[� Addition �. � ��
i
Job Site Address: � � 5�'1� , � ���j�
Owner: wL> ��. c�j(/l� L�y'l� �/'— Telephone Number: ��0.�-�"��-�7�
Mailing Address: � � Sj�' — ��7� �� f
City: ✓� �- Zip: `�'��D�
��'�:���er Contractar: � /� �Telephone Number: (p�oZ`��-r753� �
� 5
Contact Person : i/� License#: � � aC�C`� ,"�'�
Mailing Address: �`7� � � �� S )'j'���J �/�,�� �=g��
WATER SUPPLY
Lake ❑ Well ❑ City ❑
BACKFLOW DEVICE ��
AVB ❑ PVB ❑ �
Make��(C Model g�5 1 Year of Manufacture Quantity
�rinklers:
HYDRAULIC CALCULATIONS Design Data:
Area of Application: Sq. Ft.
Coverage per Sprinkler: Sq. Ft.
No. of Sprinklers:
Total Water Required: GPM
PERMIT FEE CALCULATION
1. Permit Fee: $ 50.00
2. State Surcharge $ 5.00
3. Mail-In Fee $ 2.00
4. TOTAL PERMIT FEE(Add lines l-3 above) $ ��Op
The undersigned hereby applies to the City of issuance of a Sprinkler System Permit, agrees to
do all work in strict accordance with the ordinances of the City and State regulations, and
certifies that all statei�ents made on this application are complete, true and correct.
Applicant � Date �� �) �2--
Approved Approved with Corrections Denied
Reviewed By: Date
Reset Fo�m
CITY OF ORONO
APPLICATION FOR LAWN SPRINKLER SYSTEM PERMIT
GENERAL iNFORMATION
1. You may apply for sprinkler system permits by mail (P.O. Box 66, Crystal Bay,MN
55323)or in person at the City offices(2750 Kelley Parkway). Submit plans for review
with this application.
2. 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 -0btained.
4. All work must be done in accordance with City and State Building Code requirements.
5. Two (2) sets of working plans shall be submitted for approval to the authority having
jurisdiction before any equipment is insta.11ed or remodeled. Deviation from approved
plans will require permission of the authority having jurisdiction.
Working_ lp ans shall be drawn to an indicated scale on sheets of uniform size with a plan
of the site so that they can easily be duplicated and shall show the following data:
a. Name of owner and occupant
b. Location, including street address
c. Point of compass
d. Location of septic system if applicable
e. Source of water supply
f. Pipe size
g. Pipe location
h. All control valves, check valves, drainpipes
i. Name and address of contractor
6. All wark must be inspected (final). Call(952)249-4600. 24 to 4g Hour Notice
Required
INSTRUCTIONS Complete all items on this application. Incomplete applications will not be
processed. If you have questions, call (952)249-4600. You will be notified by phone when the
permit review is complete.
p�fl��
�n .����,��.�����5
.C.FICINS Dlu�$IQH._
__� 2�S`eut(5 4"'Street-Room 30fl���
- j Minnea�Yifis;Mt��5541 5-1 31 6.
w�yv,�C L fIl1L1U�aAOIiS.mo.usLmd r
BACKFLOW PREVENTOR (R�Z) TEST REPORT
JOB ADDRESS: ��' C,-.�„ )�j��� ��r�,
J J' V
OWNER/OCCUPANT/CONTACT PERSON: T�, � CONTACT PHONE: ��� _S�_
.L-✓ � ,� � �
DEVICE LOCATION: > > ��- � FLOOR#: ROOM#:
SERVES WHAT SYSTEM: ��� `����
MAKE: !� MODEL#: �� SIZE: � � SERIAL#: n}/\�3
YJ l� f�J
INSTALL DATE(MONTHlDAY/YEAR): OVERHAUL DATE(MONTH/DAY/YEAR): TEST DATE(MONTH/DAY/YEAR):
�� (DO NOT PUT A FUTURE DATE IN THIS BOX)
��- 2�- � ��_-zS�-�z
#1 CHECK VALVE RELIEF #2 CHECK VALVE
PSI/DIFF PSI/DIFF
TEST BEFORE REPAIRS
FINAL TEST � � ��� ��
DESC.P,lBE R�PRI!?!F ANY(!F TH!S!S A NEW lNSTALLAT!ON Al�D RE?LACES AN EXIS?WG DEVIGE,INQIGATE THE SFRlPL NI.�MBFR
OF THE DEVICE REMOVED): � ��
�
TEST DONE BY(PLEASE PRINT FIRST&LAST NAME):
�/„� � � CERTIFICATION NUMBER:
�� � _ f l�
COMPANY NAME: L(j MPLS CONTRACTOR LICEFiSE#: c.�.J j
COMPANY ADDRESS: � COMPANY PHONE#: ��� - �3I
CITY: (� � STATE: � ZIP: � CONTACT PERSON/PHONE#: I
ATTACH THIS COMPLETED TEST REPORT TO PLUMBING/GASFITTING/RPZ PERMIT APPLlCl�TION aND
SUBMIT WITH FEE
7/30/2007
///� G�' f
�,t��¢�a i City of Orono I' � �jV`� FOR Ct Y USE ONLY
l�
p P.O.Box 66 a ,, � 9
�t � . ?' 2750 Kelley Parkway Date Received:����-�Permit# ���i`�� a�-3
� �� Crystal Bay,MN 55323
'��,���_�� �.���
�����r�"�t•��, Phone:(952)249-4600 Fax: (952)249-4616 Approved By: Amount$:
��'ssxn�%
CITY OF ORONO–LAWN SPRINKLER PERMIT
PERMIT CODES(IN-HOUSE)
Sprinkler/Residential/Lawn Sprinkler/Blank
SprinkledResidential/Backflow Device Only,Blank
Please Check One: New Addition
Job Site Address: �j�� ���� -��/�� ��,��
Owner: � c..�� C71/lq ��Q/'L �— Telephone Number: �(P �-� r�"�`'�-�7/
Mailing Address:,�L _S - �7�j � �. �.
City: Y U J Zip: `7���(J��
��y;l����er Contractor:� Telephone Number: (�pJ .�9�'�'j3 I
Contact Person : � License#: 0����}�(1/�
Mailing Address: �7�j� � � rj . ������� 1'y�� ������j
WATER SUPPLY
Lake ❑ Well ❑ City ❑
BACKFLOW DEVICE ����
AVB ❑ PVB ❑
'�"_ c_
Make � ' �� Model 6ar'J Year of Manufacture Quantity
�rinklers:
HYDRAULIC CALCULATIONS Design Data:
Area of Application: Sq. Ft.
Coverage per Sprinkler: Sq. Ft.
No. of Sprinklers:
Total �'Vater ReGuired: GPM
PERMIT FEE CALCULATION
1. Permit Fee: $ 50.00
2. State Surcharge $ 5.00
3. Mail-In Fee $ 2.00
4. TOTAL PERMIT FEE(Add lines ]-3 above) $��,y)�
The undersigned hereby applies to the City of issuance of a Sprinkler System Permit, agrees to
do all work in strict accordance with the ordinances of the City and State regulations, and
certifies that alL� tements made on this application are complete, true and correct.
i
Applicant ��� Date �� 3 �
Approved Approved with Corrections Denied
Reviewed By: Date
Reset Form
CITY OF ORONO
APPLICATION FOR LAWN SPRINKLER SYSTEM PERMIT
GENERAL INFORMATION
1. You may apply for sprinkler system permits by mail (P.O. Box 66, Crystal Bay,MN
55323)or in person at the City offices(2750 Kelley Parkway). Submit plans for review
with this application.
2. 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 City and State Building Code requirements.
5. Two (2) sets of working plans shall be submitted for approval to the authority having
jurisdiction before any equipment is installed or remodeled. Deviation from approved
plans will require permission of the authority having jurisdiction.
Working_nlans shall be drawn to an indicated scale on sheets of uniform size with a plan
of the site so that they can easily be duplicated and shall show the following data:
a. Name of owner and occupant
b. Location, including street address
c. Point of compass
d. Location of septic system if applicable
e. Source of water supply
f. Pipe size
g. Pipe location
h. All control valves, check valves, drainpipes
i. Name and address of contractor
6. All work must be inspected (final). Call (952)249-4600. 24 to 48 Hour Notice
Required
INSTRUCTIONS Complete all items on this application. Incomplete applications will not be
processed. If you have questions,call (952)249-4600. You will be notified by phone when the
permit review is complete.
• �IHIt Vr MINNtSUTA JIHIt VI' -1VIIIVIVt�VIH
��
MASTER PLUMBER ,, �-�� BACKFLOW PREVENTION REBUILDER ��''••..�
License# PM063200 � �'_� = License# BF063200
Expiration Date 12/31/2014 ����'�,�; ;' ' Expiration Date 12/31/2014 _
�
Effective Date O1/O1/2013 �'�•�a+,, ` Effective Date O1/O1/2013 ":�����''�
Original Issue Date 04/09/1999 Original Issue Date 05/17/1988
RICHARD M BLAYLOCK RICHARD M BLAYLOCK
9480 JEFFERY BLVD N - ' 9480 JEFFERY BLVD N
___ STILLWATER, MN 55082 STILLWATER,MN 55082
--------
; City of NIInneapolis ----- 612-673-5892----------------,
;Inspections Division � City of Saint Paul Please call for inspections
; 250 S 4� St Mpls MN 55415 2�13 � Department of Safery between 7:30 and 9:00 a.m.
'; � and Inspections Monday-Friday
� CERTIFICATE OF COMPETENCY ; I CERTIFICATE OF COMPETENCY
�Heep this card in your possession on the job. � This is to certify that: Electtacel �bb-900:
� Tg1is is to certify that: RICHARD SLAYLOCK � ' RICHARD M BLAYLOCK ; 8 �- *+�
; holds the following competencies: � i holds the following competencies: P1uminng � '"' �� '� 2b6-900:
� ; Master PUGF 19990000441 '' �'►+ :; '
; PCM825 MASTER PLUI�ER/GASlo'ITT�R � Mectt#n�t 5J �66-900�
, , ,.
i ; w*4 ,
� ..
� ; Wami A�rNeAt. �46-900�
' � i.. ,:
; � Building ' 2fi6-900:
� , rss
' � 24 hour�ufoi.ine 2G6-909f
� ; These competencies expire: 12/01/2013 �'** '�
� ' Trade.�, �t��Il: 2G6-909(
' Ricardo X. Cervantes :.� '
�
� , ,. ,
�
;THE3E COMPETENCIES EXPIRE: Nov. O 1, 2 013 �
'----------------------------------------------- �
M��H�aT��gP,��Me�� t�LllMB�IVG CONTRACTOR
� . LAB�R 8c 11+iDU�'1`RY , `
� ;:
Construction Codes and i.icensmg'Division ' Liven�ing and Certification Services 443 La#ayette Rqad I�.St.RaW,MN 55155
Website: www.dli.mn.aov/cCld.aso - 'En1siL• dli IicenseCDstate mn us Phone: 651284:5034
This is>to,certify that the certificate>holder is licensed as a PLUMBING CON'TI�ACTOR in ihe state of Minnesota and is.in compliance with
Minnssota St�tutes�2�B,A6,aucf may perform or offer to perform plumbing worl�in alt areas af the�tate during the;license period;
,. pcoVide�l ih�tesponsilile ind��+idual is at all times a MASTER PLUMBER�ttd the.certifiCate�t�ltie�11�taittt�ins cotxlpliance with the required
; bond;:general liability insurance,and workers'compensa6on laws.
License : PLUMBIN�CbMTRAC7�F� : �
Lic Number : PC6436Sy gLA�(LQGK�'LUMBING G{) B :
I
Effective Date : 01/01/20i2 7731 4TH A�fE S �
Expiration Date : 12/3�/2013 RICHFIELD, MN 55423 T
VEFtIFY UP-TO•DATE Sl'Ik'tUS, BOND,AND INSURANCE INFO ATwww.dli.mn.aov�ccld/LicVeri#v.asp'(ENTER NUMBER).
�""'�"�°T"��""�'a�''�� ``' MECHANICAL CONTRACTOR BOND
� LABOR 8c 1NQU5TRY
Construction Codes and Lieensing Division =- -_:Licensing and Certification:Services!i 443 Lafayette Road N St.Paul,MN 55155
Website: www.dli:ma.pav/ecld:aso Email: dli.license[s�state.m�.us ' Phone: 651284.5034
This is to certify that the certiticate iiolder�s register�as a ME�HANICAL CONTRACTOR BOND,in the state of Minnesota and is in compliance '-
with Minnesota Statutes 326B.197,and has filed a$25,000 mechanical bond to perform gas,heating,venrilation,cooling,air conditioning,
fuel burning,or refrigeration work in all areas of the state during the registrarion period;provided the work performed complies with
the�tate Mechanicar C4de a�d the'certificate holder maintains co�pliance vvith�►e required bond and workers'compensation laws.
Registration : MECHANICAL CONTRACTOR BOND
RegNumber : MB005190 BLAYLOCK PLUMBING CO
Effective Date : 07/01/2012 7731 4TH AVE S
Expiration Date : 07/01/2014 RICHFIELD, MN 55423
VERIFY UP-TO-DATE STATUS, BOND,AND INSURANCE INFO A'I'www.dli.mn.s�ov/ccid/LicVerifv.asp (ENTER NUMBE'
�f t U��
BACKFLt�W PREVENTOR (RPZ} TEST REPI�RT
JOB ADDRESS: �� �� 'r � ��'� �
CJ
OWNERtOCCUPANT/CONTACTPERSONr� i `'� �-1\�� CONTACTPNONE��� ��� , ��
{�
DEVICE LOCATION: � ,.��r� „��i,� ��� � FLOOR#; ROOM#:
SERVES WHAT SYSTEM: �`�.
l-/�� � �.��-�
MAKE: ��� MQDEI#: �Z� SIZE: Z O SERIAL#:�O `�D ' ?�
J J
INSTALL DATE(MONTHlDAYIYEAR): OVERHAUL DATE(MONTH/DAY/YEAR): TEST DATE(MONTHiDAY/YEAR):
l� - � 1 - ��� �o - �i-� �-
#1 CHECK VALVE REUEF �t2 GHECK VAIVE
PSIIDIFF PSIl�IFF
TEST BEFORE REPAERS
FINAL TEST �� � � l/� /j�
W�
DE3CRIBE REPAIR IF ANY(IF THIS IS A NEW INSTALLATION A D PLACES AN EXISTING OEVICE,INDICATE THE SERIAL NUMBER
OF THE DEVICE REMOVED):
I (
TEST DONE BY(PLEASE PRtNT FIRST&LAST NAME);
Chad Fiskewold CERTIFICATIDN NUMBER: 65646 BF
( COMPANY NAME: aY OC U CY� I C�g O❑ CONTRACTOR UCENSE#:
C�, CQMPA Richfield Ve O M COMPANY PHONE#: �
Y. _, _ STATE: Z�p55423 CONTACTPERSONlPHONE#:DICk
ATTACH THIS COMPLETED TEST REPORT TO PLUMBING/GASFITTlNG/RPZ PERMIT APPLICATION AND
SUBMIT WITH FEE.
1/19/2006
JUL-11-2014 09:58 P.004
BACKFLOW PREVENTOR (RPZ) TEST REPORT
Site Name:
�'dx.�.�,av
Site Address: 2�..1� ��
� �+ P�r�,A �, ��nM
Device Location on Site: � � v `
Contact Person: Irrigation by Design, lnc Phone: 763-559-7771
Serves What System: Irrigation
Test Year(check one): �New Instalf Q1st �2nd �3rd �4th aOverhaul
Manufacturer Model Size Serial Number
r�,� ,� $z��� �`` Jo�D r3�.
Install Date (M��IY): Overhaul Date (M/on�): Test Date (M��n�):
0 � f'L ���5'1
#1 Check Valve- psi Relief Valve- psi #2 Check Valve
Test Be#ore Repairs:
Final Test: 9,a � c
6 P�,ss
Describe Repairs, if any:
Test Done By: l, I l Certification
,v� a` � Number: 2�{-�C�'�
(Print first and last name) '
Company Name: (rrigation By Design, Inc �ontractor NA
` ,�_.License:
Company Address: 175 James Av. N. company 763-559-7771
Phone:
City: Minneapo(is State: MN Zip: 55405
Contact Person: Lori Waters Phone: 763-559-777'i
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