HomeMy WebLinkAbout2002-P04885 - plumbing � a
CITY OF ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: PoaaBs
Crystal Bay, Minnesota 55323 Permit Type: F►X�es
(952) 249-4600 Date Issued: 2ii ii2oo2
SITE ADDRESS: 395 Sussex Lane
I.ong Lake,MN 55356
P I D: 04-117-23-24-0007
DESCRIPTION:
Proposed Use: xesicientiai
Permit Class: Plumbing
Permit Type: Fixtures Permit Sub-type(s): Multiple Fixtures
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 375.00 Valuation: $ 30,000.00
State Surcharge Fee: $ 15.00
TOTAL FEE: $ 390.00
APPLICANT: Burton L.Pavek OWNER: 7on Campbell
4550 County Road 10 395 Sussex Lane
Watertown,MN 55388 Long Lake,MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATCIRE ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Reauired). 1-Annlicant 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
,
Feh-OB-2002 02:09Pm From-CITY OF ORONO +9522494616 T-6d7 P.005/0�6 F-248
CYTY t)F ORON� AFFLIC��TIUN F4�i.F�,UlY�ING FERMTT
Box b5 (2750 T�e11ey Faxkway)
Crystal Say, MN 55323
���A��'f�AMATION
1. Yon may apply far plumbing permits by mail or in person at rhe City offices.
2. Peru�it eards will be sent by retum mai.t afcer a review is comp�eted. P'EkIvnTS AI�B NdT VAL.YY?YJNTIL
YOU RECFIVE A P�RMIT. WQR3�_MLTS_T NOT BEGIN U d'TIL TH�FERMIT CARD IS POSTED OI�T
TH��OB SITT�
3. Plumbiag permits may be issuecl QNLY w lic�n3ed glumbing contractors and to properry owners residing
in the dvcvelling.
4. When any aew constru�tion or remodeling is invotved, a 3ep:rate building permic must be abc�aiz�d.
5. All work must be dane in accordance with the_State Code reeuueu�nts.
6. All work must be inspected and air tested l�efore it is cev�:red. CaU (9S2) 249-4b0�. 24-haur notice
reqaired.
Inst�vctio� Complete all items an this applicatian, Crnn,�ute the permit fee. Sign a�d date the
certi�cation. INGOMPLETE APP�CATrUNS WILL 1�(OT BE PROCESSED. If you have
quesuons, call {�S2) 249-4b00.
Please checl� one: ��Nevc► _,�Additiot� �tepair Replace
Residential Comme rcial
JQB�IT�: ���� ���� �«'�c([� �ip; SrS- �5^�
O�vner's Nam�: �o/� �u�''l� l3t'1 " Te]�phane Number: �5..��-- �5� _SS�'/
Nlailing AddreSs:',�`f'�i�/ Cr� c�'rt' ��n� Ci�y:/�-�T K�¢ Zip: �5���'�
Contractor's Name: J�t�t.�','TC�.�'�-��L��� Teleghaae Number:�S:�-9 S�5=3�o�
Mailin�g Address:�(S S�' C'� ,�l' !a Ci t�►:i.�T��'`�.� �ip; �,5����'
�Y.�JMSIl�ICr I'I�TURE SC��DULE
FIXT�[J'RE BSMT 1ST 21dD OTH�:R FLXTLJI� BSMT 13T �Np QTHEIt
TYPE FL �'L TYPE FL FL
Water Claset � •Z � F1oor D rai�s �
I.aGvato J '� � Sewer �'CCt4r �
�thtub � �• Tra I �
S]�ower i I i Washer I �
Kitct�en Sin1c � �►'ater l��eater
�� 5� � Water�aftener
I�ishwasher ' Wet Ba � �
L
$I�COCk3 M1SC(11'sl)
Feb-08-Z002 02:09pm Fra�-CITY OF OROMO +9522494616 T-64T P.D06/006 F-Z48
P�R'M�T F.�E CALCULATIONiS�
2Q02 State_� ❑ Yes, This $et.h:ton Appli�
The repl�cement of a �sidential fixture or a�plia�ce t iat meets all three. of tl�e following
reqairements:
I} Does nnt require modification to elecuical ��r gas service.
2) I�as a c�tal cost of$SOO.OU or less; excludiY g the cast oF t�fixture or appliance:
an�i
3) Is improved, installed or repla�ed by the hc meowner or]ic�nc�d cor�ractor.
Skip next secUon; Co:t af Pexmit $ 15.OQ
Stat� Surcharge $ .50
Mai 1 I�F�e $ -1.50
If above does not apply, follow guidelines betow:
i, Contract Price* i� .0125 % of joh wxth a iri' �m Fe�of(535.001
�x,�� _ x .0125 $ .
(conuact price} (minimum 535.0�
2. �tate Su��h�e. ** Add the State Building Code Division a (M'mimuum Fe� of$ .SO)
�j4� x .oOUS $ �
(cadtracc price) '- (miaitiaxym� .so}
3, and (Only mail-in applicatioi w) $ .54
4. TUTAL�'�12YVIIT 1+ + (Add li� 1-3 above) $
* CONI'RACT PRYC�or J�B�QST means the actual or estin t�tcd dallar ttmouac charged for the permitted
work inciuding ma�erials,labor,prafit��other fixed vosts. It is the am�t ta be charged ta the ct�swmer
for the work do�. If any material,equipmrat�labor�or ins allation are furnished by the ow�er� �enanc or
at�y anc�r party tbe reas�abla�Ic�t value c,f such nems m��c be added to tbe esrimatai cost or contr�ct
grice for permit fee p�uposes. In the event rb�c tbere is a disp<<te an the annaunc of tbe job cost,the CitY�Y
requ�t the submission of a si�+ed�o�y Qf tA+:acaraJ couaac..
*w Ttu STATE S[JRCHARG&is.0005 of�he contract price und:r$I,OUb,00b or $.50-wl�h4wer is�ester.
For valuacions over$1,000,000 caIl tbe l�eparcme�t of Ynspe xion Serviees frn the ptice,
T`he w�lersign�ed hereb� applies to th� City for issuan�ce n�a Plumbing Fermit, agx�s to do all
work in strict accorda�ce with the ordinances of the Cit y and the regulatians of tbe State of
Mi�esota, � �e�tifies that all statements made on thi s application are complete, true and
ctmtect.
Apgli�at's Signap�re: �-�"~�_� `��— Date: � ����G� �
Feb-CB-2002 02:08Pm From-CITY OF ORONO +g522494616 T-647 P.003/006 F-248
. ,
Scc.l3.04 RIGHrS OF SZISIEC'rS pF D.�,TA
Snbd. 1. 7'pp�ai data. Tha t'►8�s 4F 3Adi�du�t on whom,�e data is sm�c or m he smerd shaU be as sec tor�in�i3 sccdoa
Subd.2. IaTormaticn req�red m be g�vea iadiridQal. Aax wdiriduil sskcd:o su�piy pcivatc or cout5denrial dan coactrniag hemsaF�sbsll
be infar�ed of: (a)�he puiposa sad inuu�dcd usc of thc�qacsted dsrs witlu��o colle:an8�C agcaCY,PQuucal sabdivision,ar st$tcwidc Systcui:
tb)wherben c�msy�f�se or is IeS�Y�9����PPIY�G�4'�emd da�;t�I�Y 1�w a coasequeaec arisiag from his At�ptying or reivsia8��PPZY
. privarc Or eonfidena9i data;aad(dj�e idaadry of odter persoas tt��utid�S tushotized by :tate CC i�deral law w rsccivc t�c data. 'rhis requiremeac shaQ
no�app[y wheA an"tndiv[dual i5 dsked m iupPl3'fnvesdgadve d�m,pursuaat w sxdoa 13.$Z,s�sbdiv4sioa S,to a taw cnfosaemeac o(6cea •
Tha mminissianwr,of rcvenue tt�v plxee dsc noacc recuic�d utlder thi,s„svblivision ia tha i ividuai intome rax o�afloaern+raz�fuffi
instivctians inscead oP en thnse fa:m.s. . . • ,
Su6d.3. Access to datz bp iadividc�l. Llpon rcqaai oo i respat�sihl�=ut�o�i�y.au i�iriduai s6a!!be iatorwed wiudlor Le is$�e sabjeet
of So6red dara on individuais,and whed�er`ic fs el�sified as psi6lic,privare or coafidend d. Upon his fur�cr rr,q�asc,au ia�vidu�l whe is use subjcci
oF sraeed pcivatc Or puhlic data on iadividuals st�xU bc showu�e dsta with4u�aqy ehar 1e ao him aud.'if he desires.shaII 6c�fo[axd of die con�eaz
aAd inesn�g of t6at daa. Afier aa iadividuat has bccn showu iko privue d�ffi aad Wor ned oF ics me�g,thc Qara�eed nnt be disclose3 to hiAt tot
siz moncl�s tharcal�r uatess a di5gac�0��ctioA pursuaer m�is secdoa'ss pendiug oc u di$au�l daea on�e individusl has beca�olleersd or aratai.
Ttu tssponss'ble su�tt4tlry shall providt cap'ic5 qE tku ptiYart or public data upon c�qtics�t y the iadividual�ubjacr o[�e da�. Thc respans�ble auc6onry
psay caquuc the tequesdag pG�son ro pay d�4 aeaui eos�s of reaidug.rxraf3'inS.and ca�apiiing ihe eapies.
Thc respoas�te authori�y skalt cpmpty immed�uly.if possible,wiih aay teq aest mada pUtxuaat oo this subdivisoCn.Or wid3lfi ttve days of
rhe daic oi�w cGquest.cxcludin$Sanudays.5uadays aud tcgal holid�ys.if immedisse co nptiaace is ao�possibt�. If hq�ac r.a�ly wi�the s�queic
wid�in tt�at ticnc,he shall sv iafarm she�ndividua[.aad c�y havc aa a�idiaoaal frn days+.�thiu whieh�o eomp�y wit�tk�i�es�ezclud'ea8�Ys.
Suudaps and legsl holidays. , . �
�abd.4.-Procedars when dat�is uat accurate or ccRapict�. Ais ie�dividual maY eontcsc�he gocuracy or eompte�ucss oF pablk nr pavat,�
dat�C9ncenuag hirasclf. ?o eae�isc this:ighc,Rn individua!shali uodfy ia wridug tEu r+:spoass�Ic aut�►4ricy dtsan2fiag!he aawm of We disagt�eemem.
T�tespotcst�tIc authociq+sl�at#Withia 30 days either. (aJ�rosircc�e da�a found to Ix en�curat�or incomgle�s aad auccflpt w uodfy pas�recipicuts of'
iaar�ur�e Qr it��osnpktc dsia,iactudiag secipients pamed by zhc iadiridnal:oc(b}anti�y tIw i�iivi�t sbac�e 6e17eves rhe da�w bc cor#eec. Dam
in disput�siiail be disclossd anFy if d�e itidividuai's staiemcrU 0f di�:.grerc[ucal is intlud.�with�e disdosed dstn.
Z1�c deoera�ation oE the nespons3te�cfwaty snay ix gppeslod pursuant m cbe proviSions ef�e sdmir�s�ativc proccdtuz aa t+etadq,to
cantaso�d ases•
AATA P1tl�VACY AbYIL�1RY
�t axordance with M.S. I3.04.Subd.�, "RightS t�Fsubjects af da:a",we wauld like to iaformyou that yQurx�quest
for a perinit or Iicense from the City of Orono ar auy af it�dtpa�tme sts may reqttir� you to furaish certaizi private or
confidsuzial information. � -
Yau are notifed that: � �
1, 'l�e ix►formatio�you farnish wilt be used w determi,ua yo��r qualif�catian fat the petmit or lieense reqaested.
2. You rn�yy refuse to Supply data, but refusal may requir� that the City deny ckte permic qx licease.
3. The inft�rspation inay bt shated wirh other local, state or Fe�ral agencies to rhe extenc n�ss�y io pt'aeass
�permit or license.
4. If�our requesr�ed permit or lictuse req�ires eouncil ac xiou td �p�Cove� $ome information ufay ba'.ome
pubiic. � � � -
S. Yau have cercain rights undar Ni:S- 13A4 {aw�ilable uF an requesc} to review private data on yourself.
6.• Your full na.n�e is required to proc�ss this application or germi[.
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I nader�tand my rights as scaced abeve. �
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${�3Cilt , .r
E��� DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NO �E [.�g�-�j SCHEDULED � ( - �� �' ��
PERMIT N0. � COMPLETED �
ADDRESS � �j J L�`5c�� � P�
OWNER CONTR. IO�r�� � ic�QL'�
TELEPHONE NO r� �� �� � � ���
I U-,rl�,'''�'�
� DESCRIPTION �
tl� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILUNG
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
O 03 INSULATIGN 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINA� r 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTflR TO MEET YOU:�YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next ins ion 24 hours in advance. (952) 249-4600
OwnerlContrac si .
Inspect .
ite Copyllnspector's File Canary Copy/Site Notice
�T�'.
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NO ICE. , , scHEou�Eo 3'3 C�
PERMIT NO. � � COMPLETED j�M N
ADDRESS �..�`� 5 -��/S�C%>C C 2�i-�.
OWNER CONTR. , �,r.�/��� ���//7z�J.
TELEPHONE NO. �' �� ���..� �!'�.��
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 P�UMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 �CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING
PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
�STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-4600
OwnerlConUacto n ' e:
Inspector.
White Copyllnspector's Ffie Canary CopylSite Notice