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Home My WebLink About2011-00209 - plumbing I CITY OF ORONO PERMIT NO.: 2011-00209 2750 KELLEY PARKWAY ' ORONO, MN 55356- DATE ISSUEn: 04/1 U2011 � 952 249-4600 FAX: 952 249-4616 ADDRESS : 2500 SHADYWbOD RD PIN : 20-117-23-I1-Op34 � LEGAL DESC : REG. LAND SURVEY NO. 1630 : LOT 000 BLOCK 000 PERMIT TYPE : PLUMBING(>�500) PROPERTY TYPE : COMMERCIAL;-BUSINESS CONSTRUCTION TYPE : FIXTURE NOTE: RPZ GROUND LEVEL SMALL BOILER ROOM REPLACED RPZ#W377022 THAT SERVES THE AUTOCLACE. RPZ#473791 THAT SERVES THE HEATING TESTED OK. VALUATION OF PLUMBING , 1411 APPLICANT PLUMBING FIXTURE FEE 50.00 YALE MECHANICAL, INC. 9649 GIRARD AVE S. STATE SURCHARGE PLBG(VALUATION) 5.00 BLOOMINGTON,MN 55431 MAIL-IN FEE 2.00 (952)844-1661 , MISC FEE 0.00 �i TOTAL 57.00 OWNER , Freshwater Foundation CARGILL INC PO BOX 5626 , MINNEAPOLIS, MN 55440- ', AGREEMENT AND SWORN STATEME I T The work for which this permit is issued shall be performed ac rding to the approved plans and specifications,applicable City approval,and the State Building Code. This permit is for only the work describe and does not grant permission for additional or related work which requi s separate permiu. All provisions of laws and ordinances goveming this t pe of work shal(be compied with whether or not specified herein.This pe it will expire and become null and void if construction authorized is n t commenced within 180 days of the date of issuance,or if cons ction is suspended for a period of 180 days at any time after work has c mmenced. The applicant is responsible for assuring all required inspection are requested in conformance with the State Building Code.This pe mit may be revoked at any time for due cause! �]�, n �_ ' //�-�(. �^�.. / / �� / / Applicant Permitee Signature Date Issued ignature ate ' SEPARATE PERMITS RE UIRED FOR WORK OTHER THAN DESCRIBED AB E. � � ' //�s0 �S f � FOR C1TY USE ONLY ` `' City of Orono i'�'�,° P.O.Box 66 Date Received: Pe�mit# � "',�,;, . �,\`� 2750 Kelley Patkway ;',.. ,�i"j> �; Crystal Bay,MN 553 Approved By: Amoimt S: `�;t'e��i h;�,�s/�'' (952)249-4600 � .Rssrt�; CITY OF ORONO-PLUMBING PERMIT (All Commercial Permi Must be Approved by the State Prior to City Approval) h ://www.dli mn, ov/CCLD/P.DF! e lumb lanreva . df GENERAL INFORMATIO - 1. You may apply for plumb' g permits by mail or in person at the City offices. Applications will be reviewed and a permit wil be issued within two working days. 2. Permit cazds will be sent return mail after a review is completed. PERMITS ARE NOT VALID UNTIL YOU RE EIVE A PERNIIT. WORK MUST NOT BEGIN UNTII.THE PERMIT CARD IS POS D ON THE JOB STTE. 3. Plumbing permits may be ed ONLY to licensed plumbing contractors and to property owners residing in the dwelling. � 4. When any new constructi�n or remodeling is involved,a separate building permit must be obtained. I 5. All work must be done in�ccordance with State Code requirements. 6. All work must be inspecte�i and air tested before it is covered. Call(952)249-4600. (24-48 hour notice req ' ed) TYPE OF PERMIT Check All That A 1 ❑Residential (�Comm ial(Approval Required) ❑ New ❑Additi nal ❑Repairs ❑Replace ❑ In Accessory Structure? *You will need rior a ro al and may need CUP.(Per Orono City Code,Chapter 78,Article I� 7ob Site/Owner Information Site Address: aSOD �'�� Y�vc`�DD �c�� Owner: �/�fX�i�S�ffl�/�f�c' L�' ��/� Mailing Address: �S�GD s'fl�t}�,'G10nD.�l City: �,rG'�' '��/z- Zip: �33�3/ C�N.p�;� Home Phone:(`Sa '�� -71 � �a�< Alternate Phone: �ys��y��-97� Contractor Information: Contractor: Y�L� %�f r7/iC�� Contact Person: �ii/��-?H�f,c.'f1.5��ie1 Address: .�a0 G2� !� State Bond#: ��S�Y�i� City: v°/ i'/ Zip:SS��o Expiration Date: D<3,�.�a i� Phone: �� 1.�/ Alternate Phone: />Sa) ��/1��/ ��S = ❑ Insurance—C�urent: i��K�r�T�r.� Jnl.�� 1 . '� � PLUMB G FIXTURES BEING INSTALLED FIXTURE BSMT 1 OTI-IER FIXTURE BSMT 1 2 OTi�R TYPE FL TYPE FL FL Water Closet Floor Drains Lavatory Sewer Ejector Bathtub Laundry Tray Shower Washer Kitchen Sink Water Heater Disposal Water Softener Dishwasher Wet Bar sillcocks Mis��eous � �' G�QOC�Nl.� L�'G�L .Sj/1'I�ILG. Bd/L�/� 2dD�'/. t��r��'a R�z �h/3�o� �--h�-,:4��e��' �� " ��r�.�.�-ve. fc'G2ar �/7379/ �ha�s'�,ev�'S T�� N��n�/Gi T�ST�� O�• P RNIIT`FEE CALCULATION(S) > BA ED OFF=2002 STATE S�ATUE ❑ Yes,this section applies The replacement of only one Resid�ntial fixture or appliance tbat meets all three of the following requirements: 1. Does not require mo fication to electrical or gas service. 2. Has a total cost of$5 0.00 or less;excludine the cost of the fixture or appliance:and 3. Is unproved,installed or repiaced by the homeowner or licensed plumbing contractor. Skip next section,if 's applies; Cost of Petmit $ I5.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee S (Permit Fees Continued On Nezt age) 2 . PERMIT FEE iCALCULATION S —JOBS OVER$500.00 If above does not apply;follow guidelines below: 1. CONTRACT PRICB *is 1.25%of contract price with a(Minimam Fee of$50.00) I y/o. �'S x.0125$ SD.o0 ��one►�c�;�� om sso.00� 2. STATE SURCHAR I E **Add the State Bldg Code Div.Surcharge(Minimum Fee ot 55.00) � I /`f/0. 8"S x.0005 $ �j o 0 (contract price) (minimum S 5.00) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PEItMIT FE�(Add Lines 1-3 Above) S S�• � I ■ * CONTRACT PRICE or JOB,COST means the actual or estimated dollar amount charged for the pernutted work including mater�als,labor,profit,and other fixed costs. It is the amount to be chazged to the customer for the work do�e. If any material,equipment,labor or installations are fiunished by the owner,tenant or any other arty,the reasonable market value of such items must be added to the estimated cost or contract pri for permit fee purposes. In the event that there is a dispute on the amount of the job cost, the Ci may request the submission of a signed copy of the actuai contract. ■ **The STATE SURCHARGE ' .0005 of the contract price under$1,000,000 or$5.00—whichever is greater. For valuations over$1, 00,000 call the Building Department at(952)249-4600 for the price. PI,UMBING .ERNIIT:APPLiC;ATION,A�.TRE�MENT The undersigned hereby applies the City for issuance of a Plumbing Permit, agrees to do all work in strict accordance with e ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete, true and correct. ApplicanYs Signature: (�L�i� 1�G��z�� Date: �'� /1 I Reset Form � 3 , y ,. .:. .� -::- . � ' - M E C H A N I C A L HVAC•PIPING•SHEET METAL•MILIWRIGHT•PLUMBING BACKFLOW PREVENTOR (RPZ) TEST REPORT JOB ADDRESS: Z�"�, `� / :a OWNER/OCCUPANT/CONTACT PERSO : ` CONTACT PHONE: �=�4'� �!�� ' �� DEVICE LOCATION: FLOOR#: ROOM#: �' � l��-�- l �> L��Z.. - r y,-` 2�� SERVES WHAT SYSTEM: � ,..�—Y'3 V Ls"""ri/ I.L� t (.� MAKE: MODEL#: SIZE: SERIAL#: ^ `L, �7��xL �� j,ll;� �7 7 C �Z. INSTALL DATE(MONTH/DAY/YEAR): OVERHAUL DATE TEST DATE (MONTH/DAY/YEAR): (MONTH/DAY/YEAR): � � ��i r (DO NOT PUT A FUTURE DATE IN ( THIS BOX) #1 CHECK VALVE RELIEF #2 CHECK VALVE PSI/DIFF PSI/DIFF TEST BEFORE REPAIRS FINAL TEST � . � Z - � DESCRIBE REPAIR IF ANY(IF THIS IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE,INDICATE THE SERIAL NUMBER OF THE DEVICE REMOVED): i�f'�<J�'�!, TEST DONE BY(PLEASE PRINT FIRST&LAST NAME): CERTIFICATION NUMBER: � � a �f�� v Making uildings Work Better��r,��=�:�}�'°' . - . -... � ' , z:.� � M E C H A N I C A L HVAC•PIPIN6•SHEET METAL•MILLWRIGHT�PLUMBING BACKFLOW PREVENTOR (RPZ) TEST REPORT JOB ADDRESS: �5 J�j � � � ; �� OWNER/OCCUPANT/CONTACT PERSO `. � CONTACT PHONE: ' ' `' �,� . �I �l j L_.L- ...� DEVICE LOCATION: FLOOR#: ROOM#: \JL T �"l`./V /v�� \ "- � � 4,� r > ( SERVES WHAT SYSTEM: �i�� MAKE: MODEL#: SIZE: SERIAL#: � L� � s �'h X� �� 7_ � � � INSTALL DA E ONTH/DAY/YEAR): OVERHAUL DATE TEST DATE (MONTH/DAY/YEAR): 1� 'ZS'�/ (MONTH/DAY/YEAR): � /�'^� (DO NOT PUT A FUTURE DATE IN (��llV THIS BOX) � '��+ #1 CHECK VALVE RELIEF #2 CHECK VALVE PSI/DIFF PSI/DIFF TEST BEFORE REPAIRS 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): /£;7�f/`� G'k- TEST DONE BY(PLEASE PRINT FIRST&LAST NAME): CERTIFICATION NUMBER: ., �✓ S ,� Making B ildings Work Better sac��:�-•>�ir�a� . - - . -... �