HomeMy WebLinkAbout2010-00312 - plumbing � '
CITY OF ORONO PERMIT NO.: 2o�aoo3�2
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 06/23/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 2477 SHADYWOOD RD
PIN : 20-117-23-11-0027
LEGAL DESC : REG.LAND SURVEY NO. 0088
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURES-MULTIPLE
NOTE: PLUMBING FIXTURES: (3)WATER CLOSET,(3)LAVATORIES,(1)SHOWER,(1)WATER HEATER,(1)WATER SOFTENER
(1)URINAL,(1)DRINKING FAUCET
VALUATION OF PLUMBING 17000
APPLICANT PLUMBING FIXTURE FEE 212.50
TONKA PLUMBING HEATING&COOL INC. STATE SURCHARGE PLBG(VALUATION) 8.50
265 CTY RD 110 NORTH TOTAL 221.00
MOUND,MN 55364
(952)472-9200
Minnesota State License#: 060524-PM
OWNER
IMF
,IMF
1109 EAST MORE LAKE DRIVE
FRIDLEY,MN 55432-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. 'I'his permit is for only the work described and does
not grant permission for additional or related work which requires sepazate
pertnits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
rev ked at any time for due ca e.
�, a3, �fl ,�3� �o
plic e it e S' a re Date Iss By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
�Ma��OF 10� 10:28a TONKA PLUMBING � 952-472-9220 p.5
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�' FOR CITY USE UNLY
p�,��`� City of Oroao '`�
Q$ •vQ\�, P.O.Box 66 '^' Date Recei��/�� Permit� �/O—U ���
��i .; ��� 2750 Kelley Parkway � � �/ �
���,� �n`�'�• ;11 Crystal Bay,ivIlV 55323 Appcoved Dy, � Amount$:
�� ��.,�.�� (952)249�600
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CITY OF ORONO—PLUMBYNG PERMIT
(All Commercial permits must be approved 6y the Building Official or Inspector)
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City o.ffices. Applications will be
reviewed and a permit will be issued within two working days.
2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT
V.aI,ID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN LTITIL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Plumbing permits may be issued�NLY to licensed plumbeng contractors and to properly owners
residing in tbe dwelling.
4. When any new construction or remodeling is involved,a sepacate building permit must be
obtained.
5. All work must be done in accardance with State Code requirements.
6. All work must be inspected and air tested before it is covered. Call(952)249-46a0.
(24-48 ho�r notice required)
TYPE OF PERMIT
Check All That A 1
❑Residential �,Commercial(Approval Required)
❑1►Iew ❑Additional ❑Repairs �Replace
❑ In Accessory Structure?
"You wilt need prior approval and may need CUP.(Per Qrono City Code,Chapter 78,article IV)
Job 5ite /Owner Information:
Site Address: _�-i-1'�'� �1na�;��c,�• � �,/�z>,i•�
=Fr.�►n-✓rrC.�bnr.SZ.�i r��S�L�%✓i�-
Owner: ��,1,1�w-��.;,� Mailing Address: �� �i C ���
c;r�: ��w.o�:.����5 ►�.rJ z�p: 55�-3a-
Home Phone: �t,v"�r5�1�--�io� Alternate Phone:�a.7c Zb�— �j71" lD`��
Contractor Inforrnation:
Contractor: I �I�..-P 1 I���1-�:�-�- ���ntact Person: �L,p"�'r'��'���-t!�
Address: �,S L�.�'c.a�I I C�,.� State Bond#: �{��I' (�'��� �
City: r`V\o�.v�� Zip:��t�ExpirationDate: ���a �y� ,�.,,��.�5
Phone_ ��a-��ld- �I2�7t7 Alterna��ione� �sa- 2�c�-�{�1�
� Insurance-Cunrent: t..��
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,Ma� 06 10- 10:28a TONKA PLUMBING 952-472-9220 p.6
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PLUMBING FIXTURES�BEING INSTALLED
FTKT[JRE BSMT 1 2 OTI-IER FIXTEJRE BSN1T I 2 OTEIER
TYPE FL FL ' T�'PE ' FL FL
Watex Closet � � Floor Dcains
Lavatory � Sewer Ejector
Bathtub La�ndry Tray
Shower Washer
Kibchen Sink Water Heater M
Disposal Water Softener
Dishwasher Wet Bar
Sil lcocks Miscellaneo
1
'. , d�1�4he�"�^ �
a
PERMIT FEE CALCULATION(S)
BASED OFF -2002 STATE STATUE
❑ Yes,this section applies
The replacement of a Residential fixture or apuliance that'meets all three of the following requirements:
1. Does not require modification to electrical or gas service.
2. Has a�cost of$500.00 orless;excludinx the cost of the fiadure or a�ppliance:and
3. Is improved,installed ar replaced by tfie liomeovmer or liceosed c�nUa�ctor.
Skip next section,if this applies; , Co's't oPPermit $ 15•00
State Surch,arge $ .50
Mail-In Fee(IfApplicable) $ 2.00
', Total Permit Fee $
(Permit Fees Contioued On Vest Page)
2t
.
'May. 06 -10` 10:28a TONKA PLUMBING , 952-472-9220 p.7
PERMIT FEE CAL,CULAT�ON S —70BS �VER$SOU.00
Tf above does not apply;follow guidelines below:
1. CaNTRACT PRICE *is 1.25%of cflntract price with a(Minimam Fee ot S50.Q0)
� ��qc"�� x.O l 25$
(coimaa price) , (minimum 550.00)
2. S�'ATE SURCAARGE **Add the State Bldg Code Div.Sutcharge(Minimum Fce ofS.50)
( 1,a (�� x.0005 $
(contractpria) (minimurnS .50)
3. POSTAGE&HANDLIlVG(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines,l-3 Abovej S
■ * COA�TRACT PRICE or JOB COST means the actual or esEimated dollar amount charged for the
permitted work including materials, labor,profit, and other fized costs. It is the amount t,o be charged
to the customer for the work done. [f any maLerial,equipmeM,laboc or instaElations are furnished by
the owner,tenant or aay other party, die reasonab[e rnarket value of such items must be added to the
estimated cost or cocrtract price for permit,fee pwp�es. In the eve�t that �ere is a dispute on the
amount of the job cost,the City may request the subn►ission of a signed oopy of the actual contract
■ **The STATE SURCFiARGE is ,0005 of the contract price under $1,OOD,000 or$.50—whichever is
gea�ter. For valuations over$1,000,000 call the Building Department at(952)249-4600 for the price.
PLTJMBING PERMIT APPLICATION AGREEMENT
The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all
work in strict accordance with �the ordinances of the City aifd the regulations of the State of
Minnesota, and cectifies that all statemeirts made on this application are complete, true and
correct.
Applicant's Signature: ' Date: '�/�D !� �
Reset Form
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May 06 10 10,29a TONKA PLUMBING 952-472-9220 p.10
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PLEASE CHECK YOUR CARDS FOR ACCURACY.
fF YOU FIND AN ERROR,PLEASE CALL 651.284.5031
. IMMEDIATELY,
WALLET D�SPLAY COPY
_ STATE OF MINNESOTA
HASTER PLUMBER ��� .
. Registration�60524-PM
Expiration Date 12/31/2010 a� ' .�-
Original Date Issued 10/18/20D2 �''��``
SCOTT B FROVARP
8709 HILI.VIEW DRIVE EAST
ST BONIFACIUS, MN 55375 L .
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�May t�6 10 10,29a TONKA PLUMBING 952-472-9220 p.9
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CFRTIFICATE OF INSURANCE
Th �difiae�fh t � STATE FARM F�RE AND►^,ASUALIY COMPANY, Bloomington, IlYnois
❑ S7ATE.FARM GENERAL INSURANCE GOMPANY, Bloomington,lllinois
❑ STATE FARM F[RE AND CASUALTY COMPANY,Scarborough, Ontarlo
�Na�.•«ccr, ❑ STATE FARM FLORIDA INSIlRANCE COMPANY,INinGer Haven,Flo�da
❑ SYATE FARhA LLOYOS, dallas,Texas
insuresthe following poGcyholder ior Ihe eoverages indicated belaw:
Narne of polic.yholder T���a4 PLUMBING 1i$AT=I:G Fti!D COGI,YN^o �tac
Address of palicyholder 265 CfY RD 110 h MOUND t+�, 55304
Location OF operations MIt]NESOTA
Descsiptian o?operalions PLOHBiNG, r�ATZtiG RHC �oOLZNG
The policies lisfed below have been issued to the poficyhdder fpr the po�rcy peri�s shown_ The insurance descdbed in these policies is
subject t�aA the lerms ezdusions,and concfitio�.s of ihose poaaes. The limits af liability shown may have been redueed by any paid claims.
POItCY PERIOD LlMpTS OF LIABIUTY
POLICY NUMBER TYPE OF INSURANCE E(fective Date : 6cpirdtion Datie {at beginnin of poiicy period)
93-B9-tTi52-1 F �omprehensive 01/01/ZOlO ; 01101f2011 BQDILYIN.IURYAND
�
Susiness Liabiliry ' _ PROPERTY OAMAGE
Thisinsuranceindudes: �Prod�cfs-CompfetedOperations -------�•---------------
❑ Contrach�al llabiliiy
❑ Underground Hazard Coverage Each Occur�e�ce $soo,��o�
_ ❑Personal lnjury
❑Advertisirg Injury General Apgregate $ _,OCO,000
❑ Explosion Hazard Coverage
❑CoYapse HazardCoverage Praducts—Completed $_,oao,C0o
aOperalio�s Agg regate
POLICY PERI00 BOOILY INJURY ANQ PROPERTY DaMAGE
EXCESS UABILITY E���Date � Expieation pa� {Corr�ined Single Umi{j
❑ UmbreQa ; Each Occurrence $
❑Other re aie $
' Par!1 STATUTORY
93-K4832-6 workers comp oi!�i/2�10 � D4/30/2011 Part 2 B{3DILY(NJURY
Each Aocident $50�,000
Disease Each Empbyee �500,000
� Disease-Pdicy Limit �5CO3 Doo
PaUCY NUMBER TYP�aF INSURANCE �UCY PERIOD LiYIITS pF UABIUTY
Eifective Date ; Expi�atioa Date [at 6eginRin oF pol;cy period)
.
�
THE CFRTIFICATE OF fNSURANCE IS N�T A CONTRACT OF INSURANCE AND NEITI�ER�LFFIRiVlATIVELY T10R NEGATIVELY
I�AEN0.5,EXTENDS OR AI.TERS THE COVERAGE APPKOVEO BY ANY POLICY OESCRIBE�HEREIN.
If arty of�he described po8cies aze canceted before
its ezpiration date.State Fa�m will try lo mal a written
nortice tothe certificate holder
�ame and Address ot Cerlificats Helder 30 days�before rancellation. II however, we fai) to
Cit�r Of Orono mail ch notice, �o obllgatlon or liabilily will be
p.c. aox 6s , � � � a� Far�t or its a�gents or
2750 Kelley Paxkway ' n�� .
Crystzl 8ay, �1N 55323 `�
, � 5 natu Autnorized ReArosentatFre
� A ent 0�/29;2010
, TiNe Dabs
I Agenia Code Stamp
.,�„�.••• ROGER Q F�fES�C.P.C.tI,AGENT
. O fSA'Q'E FAIiIN MSUR�INCE�IJ��i100ti'i05t
ssa•98Ma.9 06.tY89 PTOed.nU.S,A. �waruru ����L)NEDRlVE�.O.BODC153
�I�LIF►D,MMNESOTA 55964
� PHONE 951-172-5968 FAX 952�72-�Z68
May 06 10 10:29a TONKA PLUMBING 952-472-9220 p.11
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engage in the pl�bfng trdde in al1 areas of the stabe af Mn�esota.
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MOUND,MN 55364
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2 O� O Band ID: 93 J4 6807 7 , Liability Inswarxe lD: 93 BB V855 4
STATE FARM FIRE AND CASUALTY STATE FARM 1NS CO
COMPANY
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May 06 10 10:29a TONKA PLUMBING , ; � 952-472-9220 p.12
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� ' Bond ID: 93,14 6775 8 , Effective pafie; 11/26/20
STATE FARiIA FIRE� CASUALTY'Cp � �:i . 0�
Expiration Date: 11/26/2010
�� � �jD TIME �
CITY OF ORONO P��S 2CALLED IN *� ��
INSPECTION NO ICE U ����sCHEDULED ��
PERMIT NO. - �COMPLETED
ADDRESS � ��� �����:��lG�%Y�l`��!�_
OWNER LEPHONE NO�S� ��"g��
CONTRACTOR
� DESCRIPTION � `
�
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL '�'10fECHANICAL RI ❑ LAKESHORE/WETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL
O ❑ TREE REMOVAL
Z ❑ INSULATION " ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
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v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
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� OWNERICONTRACTOR TO MEET YOU:_YES_NO
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❑STOP ORDER POSTED.CALL INSPECTOR
❑ IIVSPECTION REQUIRED.CAII TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
OwnerlContractor on ite:
Inspector. /1
White Copyllnspector's File Canary CopylSite Notice
�— � �� TE TIME -✓
CITY OF ORONO CALLED IN 7�� �0
INSPECTION NOTICE SCHEDULED / ��
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Q ❑ FRAMING �MECHANICAL FINAL ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
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V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Cail forthe next inspection 24 hours in advance. �952� 249-46��
OwnerlContractor on site:
Inspector. �
White Copyllnspector's File Canary CopylSite Notice