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Home My WebLink About2011-00210 - plumbing CITY OF ORONO PERMIT NO.: 20��-002�0 ° '2750 KELLEY PARKWAY � ORONO,MN 55356- DATE ISSUED: 04/1 U2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 2500 SHADYWOOD RD PIN : 20-117-23-11-OU34 LEGAL DESC : REG. LAND SUiRVEY NO. 1630 : LOT 000 BLOCK 000 PERMIT TYPE : PLUMBING(>$500) PROPERTY TYPE : COMMERCIAL-BUSINESS CONSTRUCTION TYPE : FIXTURE NOTE: RPZ-LOWER LEVEL BOILER ROOM RPZ'�HAT SERVES THE HEATING SYSTEM TESTED RPZ SERIAL#274415 OK REBUILT RPZ SERIAL#729098 OK AFTER REBUIL� VALUATION OF PLUMBING 506 APPLICANT PLUMBING FIXTURE FEE 50.00 YALE MECHANICAL,INC. STATE SURCHARGE PLBG(VALUATION) 5.00 9649 GIRARD AVE S. � BLOOMINGTON,MN 55431 MAIL-IN FEE 2.00 (952)844-1661 MISC FEE 0.00 TOTAL 57.00 OWNER Freshwater Foundation CARGILL INC PO BOX 5626 � MINNEAPOLIS,MN 55440- AGREEMENT AND SWORN STATEME T The work for which this permi[is issued shall be performed acco ding to the approved plans and specifications,applicable City approvals, nd the State Building Code. This permit is for only the work described d does not grant permission for additional or related work which require separate permits. All provisions of laws and ordinances governing this ty e of work shall be compied with whether or not specified herein.This perm will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if constru tion is suspended for a period of 180 days at any time after work has co menced. The applicant is responsible for assuring all required inspections e requested in conformance with the State Building Code.This pe it may be revoked at any time for dye cause. ��'�tRt�t �-�'� / / ��,� /y � l l , ....�„�., Applicant Permitee Signature Date Issued By ature Date SEPARATE PERMITS REQ IRED FOR WORK OTHER THAN DESCRIBED ABO . //flGy� , �5� � • FOR C1TY U3E ONLY If/`¢��\�\ P.O Box Orono �R�n,� Pe�mit# j��y�, � � 2750 Kelley Parkway �4 �'�� crystat say,bnv ss3?.3 A.p�oved sy: amwunt s: -,�� (952)249�4600 � CITY 0�1 ORONO-PLUMBING PERMIT (All Commercial Permit�Must be Approved by the State Prior to City Approval) h :I/www.d 'mn. ov/CCLD/PDF! e lumb lanreva . df GENERAL INFORMATIO 1. You may apply for plumb�ng 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 retum mail after a review is completed. PEItMITS ARE NOT VALID UNTII.YOU RF,�EIVE A PERMIT. WORK MUST NOT BEGIN UNTII.THE PERNIIT CARD IS POS�ED ON THE JOB S1TE. 3. Plumbing permits may be�ssued ONLY to licensed plumbing contractors and to property owners residing in the dwelling. 4. When any new constructiqn or remodeling is involved,a separate building permit must be obtaiaed. 5. All work must be done in�ccordance with State Code requirements. 6. All work must be inspected and air tested before it is covered. Call(952)249-4600. (24-48 hour notice requu+ed) TYPE OF PERMIT Check All That A 1 . ❑Residential �Comm�rcial(Approval Required) ❑New ❑Additio�al ❑Repaira ❑Replace ❑ In Accessory Structure7 *You will need nrior anarovril and may nced CUP.(Per Orono City Code,Chapter 78,Article I� Job Site/Owner Information: Site Address: aSOD s��-a ywaod Ro� _ Owner: �'aRf'�.5�lfWHT� ��T�1� Mailing Address: �5-OD��Oy��ooD� City: �,�'G' �/U2 Zip: 5�"33/ ��.pi� Home Phone:l95-2� '79/.-7�y9 P,Po�< Alternate Phone: �95��/-977�.3 Contractor Information: Contractor: Y L� ��f i G Contact Person: �N�/��,�D.S�n/ Address: .�a0 Gr� !�' State Bond#: !0 5�54��J City: B/ /J � Zip:SS�� Expiration Date: I�<3��0�� Phone: � S� �� / Lo/ Alternate Phone: /9Sa) Fr��/1P�/ � y� ` ❑ Insurance—G�rrent: F��,O�iPf/T�',�S I n��e� � 1 PL Gr'�1��E�'►': r.. ��" ._.� FIXTURE BSMT 1 2 OTi�R FIXTURE BSMT 1 2 OTf�R TYPE FL FL TYPE FL FL Water Closet Floor Drains Lavatory Sewer Ejector Bathtub ��Y T�Y Shower W��' Kitchen Sink Water Heater Disposal I Wa�So��' Dishwasher Wet Bar Sillcocks Miscellaneous �� L-�j�,Ocv�' L�'v�G ��GP� �E'DOf1�//P/'� Ti��-T s�v�S rH� �-Tnl� �jYsT�.�/. II � r�;5'T�b 2PZ �'�/�t�-� 2��yls= o,� � l�Bur�T /�PZ S�i� ��oy�=OKA�TP�'— j ,�Bui� � � �� : , � �� "�� `' � n�:� �. w� ❑ Yes,this section applies The replacement of only one Reside�tial fixt�ue or appliance that meets all three of the following requirements: 1. Does not require modi�ication to electrical or gas service. 2. Has a total cost of$5 .00 or less;excludine the cost of the fixture or appliance:aad 3. Is improved,installed�r replaced by the hom�wner or licensed plumbing contractor. Skip next section,if th�s applies; Cost of Permit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee S (Permit Fees Continued On Neat age) I 2 PERNIIT FEE CALCULATIC?l�l`S =-� HS,��,$��!O:�Q. :;: If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of 550.00) .�OS 75 x.0125$ ,50. � (coQhact price) (minimam SS0.00) 2. STATE SURCAARC�E **Add the State Bldg Code Div.Surcharge(Minimnm Fce of 55.00) ,,�DS 7S x.0005 $ S. � (conhact pace) (minimum S 5.00) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERNIIT FE�(Add Lines 1-3 Above) $ J'�� `� ■ * CONTRACT PRICE or JOg COST means the actual or estimated dollar amount charged for the permitted work including mateXials,labor,profit,and other fixed costs. It is the amount to be charged to the customer for the work dpne. 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 addad to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute oa the amount of the job cost, the Cit�may request the submission of a signed copy of the actual contract. ■ ••The STATE SURCHARGE lis.0005 of the cont�act price under$1,000,000 or$5.00–whichever is greater. For valuations over$1�000,000 call the Building Department at(952)249-4600 for the price. �"' �, ��, � '� r� . , �_ �a , � k , � j �. ;', , �'�4 � i . � . a -. � y . %.. Yq ...'4b'r�5p s.. The undersigned hereby applies ito the City for issuance of a Plumbing 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 al} statements made on this application are complete, true and correct. ApplicanYs Signature: �� cc,� �_ Date: °3 a3✓. !! —�.. Reset Form ' 3 . }-�� ALE M E C H A N I C A L HVAC•PIPING•SHEET METAL•MILLWRIGHT•PLUMBING BACKFLOW PREVENTOR (RPZ) TEST REPORT ��Ng JOB ADDRESS: � `::� ��: � ,� OWNER/OCCUPANT/CONTACT PERS . CONTACT PHONE: � Z L-� � ..S 2, DEVICE LOCATION: FLOOR#: ROOM#: ��L � L SERVES WHAT SYSTEM: -"�C MAKE: ' MODEL#: SIZE: SERIAL#: �,I L t-.tS �,. � �, Z �Q, INSTALL DATE(MONTH/DAY/YEAR): OVERHAUL DATE TEST DATE �Q `C�� (MONTH/DAY/YEAR): (MONTH/DAY/YEAR): (DO NOT PUT A FUTURE DATE IN THIS BOX) .Z` _ #1 CHECK VALVE RELIEF #2 CHECK VALVE PSI/DIFF PSI/DIFF TEST BEFORE REPAIRS 4y � � �. � I . FINAL TEST /, . DESCRIBE REPAIR IF ANY(IF THIS IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE,INDICATE THE SERIAL NUMBER OF THE DEVICE REMOVED): (��_r',�41 L t" TEST DONE BY(PLEASE PRINT FIRST&LAST NAME): CERTIFICATION NUMBER: / � � _ 5-. Making uildings Work Better;F��=.�-�� . - - . -... � � 4� ALE M E C H A N I C A L HVAC�PIPING•SHEET METAL•MILLWRIGHT•PLUMBING BACKFLOW PREVENTOR (RPZ) TEST REPORT �� dl�`f� JOB ADDRESS: �� - c � .,� � OWNER/OCCUPANT/CONTACT PERSON: �, , r�f� � CONTACT PHONE: /`�� , � � �� DEVICE LOCATION: FLOOR#: ROOM#: �A � i..'L, ' L I_ SERVES WHAT SYSTEM: Z ,�-`—r a MAKE: MODEL#: SIZE: SERIAL#: �`��k`�.� �i �z�� z 7 �{ I � INSTALL DATE(MONTH/DAY/YEAR): OVERHAUL DATE TEST DATE (MONTH/DAY/YEAR): (MONTH/DAY/YEAR): (DO NOT PUT A FUTURE DATE IN THIS BOX) ��°j'r� �� #1 CHECK VALVE RELIEF #2 CHECK VALVE PSI/DIFF PSI/DIFF TEST BEFORE REPAIRS FINAL TEST � . � �� ' ��E� DESCRIBE REPAIR IF ANY(IF THIS IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE,INDICATE THE SERIAL NUMBER OF THE DEVICE REMOVED): T�'`�i��rJ c,-�i� TEST DONE BY(PLEASE PRINT FIRST&LAST NAME): CERTIFICATION NUMBER: '� '� E7 C�S S �3 ,I Making I uildings Work Better Since 2�3'3 . - . -... �