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Home My WebLink About2012-00505 - plumbing . . CIT OF ORONO * Z 0 1 2 - 0 0 5 0 5 * 2750 KE LEY PARKWAY DATE ISSUED: 06/1U2012 ORO O, MN 55356- 952 249-460 FAX: 952 249-4616 ADDRESS : 2500 SHADYWOOD RD PIN : 20-117-23-11-0034 LEGAL DESC : REG.LAND SURVEY NO. 1630 : LOT 000 BLOCK 000 PERMIT TYPE : PLUMBING(>$500) PROPERTY TYPE : COMMERCIAL-BUSINE�S CONSTRUCTION TYPE : FIXTURE NOTE: 1 RPZ VALUATION OF PLUMBING 845 i APPLICANT pLUMBING FIXTURE FEE 50.00 YALE MECHANICAL,INC. STATE SURCHARGE PLBG(VALUATION) 0.42 9649 GIRARD AVE S. BLOOMINGTON,MN 55431 MAIL-IN FEE 2.01 (952)8441661 TOTAL 52.43 OWNER Freshwater Foundation CARGILL INC PO BOX 5626 MINNEAPOLIS,MN 55440- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections aze requested in conformance with the State Building Code.This permit may be revoke t any time for due caus . �/ �� / / �O/ �� / / �-- Applicant Permitee Signa re _ Date Iss By Signature Date SEPARATE PERMITS REQUIRED F R WORK OTHER THAN DESCRIBED ABOVE. JU��%��7/2�12/THU 09: 4Z AM Yale Mechanical FAX No, 952-884-0295 P, 002 ia�G�� s�,,�.: ci us�o1vY.�r ��'`'-�� City of Orono �/�� QS /j��' '� P.O.gox 66 Dato Received: 7 ��' Petrnit# `"I'� �r ��-� .,,, ��' 2750 Y{sUey Psrkway � � II �8�1 Bay,MN 55323 �►PP�Ved gy: ��ount$; `�� (952)249-4600—Main ,�� (952)249-4616—pax CIT'i'" O�' ORONO—PLUMB7I�TG PERM�T (All Commercia�Permits Must be Appro�ed by the State Prior to City Approval) ht ://'�v'ov�v'.dlf.mn. ov CCLD/PDF/ e lucmb lanreva . df GrENB�TI�T�O1tMATION 1. You may appl�for plumbing pennits by mail or in pereon at tlie City offices. Applications will be reviewed and a pem�it will be iasued within two worlcing days. 2. Perxnit cards will be sent by return mail atter a rorriew ie completed. P�RMI'i`S ARE NOT VALID UNTIT.'SCOU RECEIVE A PERMT'T. WORK ML7ST N'OT BEGIN UNTIL THE PERMIT CARD YS POS'�A ON THE JOB SITE. 3. Plumbing permits may be issued ONLY to liccnsed plumbing eontraetors aud to property ovvners residing in the dwelling. 4. �Vlrhen any new construction or rcmodcling ia involved,a separata building permit mtYst be obtained, 5. All work anust bo donc in secordance with State Code raquircmcnts. 6. ,A,11 work must bo inspected�nd sir tested befora it is cova�ed. Csll(952)249-4600. (24-48 hour not�ce regulred) � , TYPE OF PERNIIT . �.. Cliecic All That A ' 1 : � ❑Residential Q Comrnercial(Approval Required) ❑New ❑A,dditional ❑Repa�s ❑RePlace ❑ 7n Accesaozy Structure? '"You wi�l need nrior a�»ro�vai and may need�.(Par Orono City Code,Chapter 78,Article I� Job Site/Owner Ynforma�ion:� � � . . Site Address: 2500 Shadywood Rd o,��,Cargill Freshwater Mailing Address: 2500 Shadywood Rd Cl�: Excelsior z;p; 55331 Iiome Phone: �952) 471-9773 ��phone: Contractor Information:. �. contractor: Yale Mechanical Contact Peraon; angie Richardson ��8g; �Zo we$►8,$t S�eet s�,te Bond#: 59978PM City: Bloomington Zip:S�� ExpirationDate: 12/31/12 Phone; (952) SS4-1661 Altennate Phone; 0 Insurance—Curren� 1 i /alG��i �.Sa`L,y� , r � � FOR CITY USE ONLY City of Orono O¢��O P.O.Box 66 Date Received: Pernut# 2750 Kelley Pazkway a n•.�• Crystal Bay,MN 55323 APProved By: Amount S: �+ �' k � (952)249-4600—Main �tssx�' (952)249-4616—Fax CITY OF ORONO—PLUMBING PERMIT (All Commercial Pemuts Must be Approved by the State Prior to City Approval) htt ://www.dli.mn. ov/CCLD/PDF/ e lumb lanreva . df GENERAL INFORMATION 1. You may apply for plumbing permits by mail or in person at the City offices. Applications will be reviewed and a pemut 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 UNTIL YOU RECEIVE A PERNIIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property owners residing in the dwelling. 4. When any new construcrion or remodeling is involved,a separate building permit must be obtained. 5. All work must be done in accordance 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 required) TYPE OF PERMIT Check All That A 1 ❑Residenrial ■0 Commercial(Approval Required) ❑New ❑Additional ❑Repairs ❑Replace ❑ In Accessory Structure? *You will need urior aparoval and may need CUP.(Per Orono City Code,Chapter 78,Article I� Job Site/Owner Information: s;te Ada�ess: 2500 Shadywood Rd owner:Cargill Freshwater Mailing Address: 2500 Shadywood Rd c;ty: Excelsior Zlp: 55331 Home Phone: �952) 471-9773 Alternate Phone: Contractor Informarion: contraotoT: Yale Mechanical Contact Person: Angie Richardson Address: 220 West 81st Street State Bond#: 59978PM City: B�oomington Zip:5�20 Expiration Date: � Z�3�� 2 Phone: (952� 884-1661 �ternate Phone: � Insurance—Current: 1 � _ PLtJM�ING � ' � � . .� . � .: �r r � .. . , . . _ FIXTURE BSMT 1 2 O FIXT(JRE BSMT 1 2 OTf�R TYPE FL FL TYPE FL FL Water Closet Floor Ihains Lavatory , Sawe�Ejoctor Bathtub Laundry Tray Shower Washer � Kitchen Sink Water Heater Disposal Watet Softener Dishwasher Wet Bar siticocks M'�� 1 RPZ ��. rt:�,v � , � ��' �: ��7.� ❑ Yes,this section applies Tho replacement of only one R�idential fixture br a�roliance that mcet�all thrce of the following �� 1. I�es not require modification W el 'cal or gas service. 2. Has a t��of$500.00 or less; the cost of the fi�u��appliance:aad 3. Is improved,installed or replaced the y��eowner or licensod plumbing contcactar. Skip next section,if this applies; Cost of Permit S 15•00 State Surcharge S 5•00 Mail-In Fce(If Applicable) S 2.00 Total Permit Fee S (Permit Fea Continacd On Nezt Pu�e) 2 PERMIT FEE CALCULATION S —JOBS OVER$500.00 If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) 845.00 X.0125$ 50.00 (contract price) (minimam S50.00) 2. STATE SURCHARGE g45.�� .43 x.0005 $ (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00` 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S`��.�� ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount chazged for the pemutted work including 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 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. PLUMBING PERNIIT APPLICATION AGREEMENT T'he undersigned hereby applies to 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 all statements made on this application are complete, true and correct. Applicant's Signature: � � ��nt-�' Date: �`�`�!'�-- Reset Form I, 3 � , � : M E C H A N I C A L HVAC•PIPING•SHEET METAL�MIL�WRIGHT•PLUMBING � � ti� �� BACKFLOW PREVENTOR (RPZ) TEST REPORT JOB ADDRESS: WORK ORDER �5 v c� � 1-�.� �,: � V�� 2 «� 1 � `� � 7� OWNER/OCCUPANT/CONTACT PER ON: CONTACT PHONE: � C�c �� '.��c.--� c�.� � DEVICE LOCATION: FLOOR#: ROOM#: (� � � ; � . ll��% �1-� r c�ti`�� SERVES WHAT SYSTEM: � s,r�G "�'�t0� MAKE: MODEL#: SIZE: SERIAL#: C��—�`J `�0 � ,� n ��7`I �f I 5 INSTALL DATE(MONTH/DAY/YEAR): OVERHAUL DATE TEST DATE (MONTH/DAY/YEAR):� �I- �� (MONTH/DAY/YEAR): (DO NOT PUT A FUTURE DATE IN THIS BOX) #1 CHECK VALVE RELIEF #2 CHECK VALVE PSI/DIFF PSI/DIFF TEST BEFORE REPAIRS /�� 1.�: �C FINAL TEST CL ; �. � %i�� DESCRIBE REPAIR IF ANY(IF THIS IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE,INDICATE THE SERIAL NUMBER OF THE DEVICE REMOVED): � c� �}-�. I 1 �'�`��T �^ �+— — 7�/ �� . �� , TEST DONE BY(PLEASE PRINT FIRST&LAST NAME): CERTIFICATION NUMBER: Chris Hynes 063305BF Making Buildin Work Better Since 1939 + -... � r , . Minnesota Department of Labor and Industry j Licensing and Certification Services Construction Codes and Licensing Division , Phone: 651.284.5034 443 Lafayette Road N � Email: DLI.License@state.mn.us Saint Paui, MN 55155 , � � �� Website: www.dli.mn.gov/ccld.asp � .�� L �� 2�'<� J �O NOTICES � ��j,9 ��lJ,� NOT TRANSFERABLE 2/� "� CHANGE YOUR BUSINESS STRUCTURE YALE MECHANICAL LLC SUBMIT A NEW APPLICATION FOR NEW ENTITY � 220 W 81 ST ST RENEW OR REPLACE INSURANCE POLICY BLOOMINGTON, MN 55420 SU�MIT NEW CERTIFICATE OF INSURANCE ' NQTIFY THE D�PARTME�NT OF A CHANGE IN YOUt� BUSINESS. �ailure to dq so,subjecfs you to administrative pen Ities of up;ta$1D,ODQy 15-Day Notice Requirement—Forms available online af .dli.mn. ov/CCLD/LicU ate.as • Change in business'physical address,maiting addr ss,phone number,or email address , > , , • Change in control,owners;afffcers,dir�ctors,memb rs,partners ' • Change in business'legal narne andlor assumed na e.! • Loss of or change in MASTER PLIJMBER •< Changs in general liability insurance or workers'co pensation insuranee:coverage , Immediat�Nofice Requirement—Notification to DLI in wri ng +: Judginent DebtQr. A licensed contractor has 15 day to pravide written'notice of thie finding that it is found to be a judgment debtor based upon conduct requiring licensure. • Bankruotcv Petition Filed. >A licensid contra�tor has 5 d�ys to provide written notice that it filed a petifion for bankruptcy. • Conviction Notice. A licensed contractv�has 1 Q day fc�provide written notice that it has been found guifty of a felony;gross' misdemeanor, misdemeattor or ;any cQmparabl offense related to the licen�e, including convictiuns o# ':fraud, misrepresentation,mtsuse of funds;theft,��iminal se ual conduct, assault, burglary,conversion af fur�ds, or theft of proeeeds in this or any other state or any other United States ju isdiction. YOUR CERTlFICATE tS BEL.OW THE PERFORATION. ' SHO1N CERTIFICATE WHEN OBTAINING PERMITS. � _ ; ' MtNIVff$QTAD@PARiMENT�.QE : �'�.0 BI��NG CONTRACTOR � �.�a,s�t�& ��a��T�r ` ' Construction Codes and Licerlsing Divisi4n ' Li Sing and Certification Services 443 Lafayette Hoad N Sk P2u1,MN 55155 Website: www.dli.mn.aov/ccfd.aso - mail: dli.licenseCa�state.mn.us Phone: 651.284:5034 This is::to certify that the cextificate holder is licensed as a PLUMBIN CONTR.A.CTOR�n the state of Minnesota and�s in compliance with MinnesoYa Statiutes 326B.46,aiid may perform or offer to perform pl bin�wock'rn a�l areas nf the state during the license period; prauided the respo�nsible individual is at all rimes a MASTER PLUM ER`and the certificate h4ldermaintains compliance with the required ' band„general liability insurance,and workers'compensation laws. License : PLUMBING GONTRACTOR �- Lic Number : PC644631 YA�.E M��HANICAL LL � Effective Date : 01/01/2012 22Q w$'#ST ST B < Expiration Date : 12/31/2013 BLOOMINGTON, MN 5 420 � r I VERIFY UP-TQ-DATE STATEIS, BOND,AND INSURANCE IN�O ATwww.dli.mn.qovlccldlLicVerifv.asu (ENTER NUMBER). � ,e;,�s.�<o,�s <; MINNESOTA DEPT.OF LABOR AND INDUSTRY PLEASE CHECK YOUR CARDS FOR ACCURACY. CONSTRUCTION CODES AND LICENSING IF YOU FIND AN ERROR,PLEASE CALL 651284.5031 443 LAFAYETTE RD. IMMEDIATELY. 8T. PAUL,MN 55155 WALLET DISPLAY CARD STATE OF MINNESOTA ��. THIS LICENSE MUST BE IN YOUR POS .:�o�,o�... � MASTER PLUMBER `�� DURING WORKING HOURS. License# 059978-PM ��.- _ _: .� Expiration Date 12�31l2012 t�� PLEASE NOTIFY CONSTRUCTION CO �. 10/25/2010 �� LICENSING OF ANY ADDRESS CHAN �� ;, . Original Issued Date MICHAEL P HOLMGREN 4892 BOL6ER TRL INVER 6ROVE _H_GT, MN 55076 � _ +_ _ -— - - -- - - - P - - - - - -- -. -. _ F -- -- L C