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HomeMy WebLinkAbout2000 - P02045 - plumbing PERMIT CITY OF ORONO 2750 Kelley Parkway - PO Box 66 Permit Number: P02045 Crystal Bay, Minnesota 55323 Permit Type: Fixtures (612) 249-4600 Date Issued: 2/22/00 SITE ADDRESS: 85 Wear La N LONG LAKE, MN 55356 PID: 33-118-23-34-0005 DESCRIPTION: Proposed Use: Resiuciitiai Permit Class: Plumbing Permit Type: Fixtures Permit Sub-type(s): Water Closet Lavatory Bathtub Watcr IIeater DETAILS: Wet Bar Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 2,200.00 State Surcharge Fee: $ 1.10 TOTAL FEE: $ 36.10 APPLICANT:NT: Ka 'c Plumbing OWNER_ M P&G M SIEVERT MIS 1wry OWNER_ 12524 94th Place 85 WEAR LA N Maple Grove,MN 55369 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. Ity6L 6? LU,I 1:7‘131/ANT PERMITEE S NATURE ISSUED BY SIGNATURE Cl/ Copies: City,Applicant,Assessor,Finance Page 1 CITY OF ORONO APPLICATION FOR PLUMBING PERMIT Box 66 (2750 Kelley Parkway) Crystal Bay, MN 55323 GENERAL INFORMATION 1. You may apply for plumbing permits by mail or in person at the City offices. 2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. 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 construction or remodeling is involved, a separate building permit must be obtained. 5. All work must be done in accordance with the State Code requirements. 6: All work must be inspected and air tested before it is covered. Call 249-4600. 24-hour notice required. Instructions Complete all items on this application. Compute the permit fee. Sign and date the certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call 249-4600. Please check one: New Addition Repair Replace X Residential f Commercial JOB SITE: 85 ear L i . /V, Zip: Owner's Name: /1/,E444./ S,'e ,^.1— Telephone Number: . Lc?3-w33 Mailing Address: ,S4 m t City: /ron o Zip: Contractor's Name: Ar Telephone Number: Gi,p-4699.3 ^ 06 Mailing Address: City: Zip: PLUMBING FIXTURE SCHEDULE FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER TYPE FL 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 Misc (list) PERMIT FEE CALCULATION 1. 1.25% of Contract Price* or Minimum Fee ($35.00) ./{ 2,2 da x .0125 $ (contract price) 2. State Surcharge. ** Add the State Building Code Division Surcharge to each permit. x .0005 $ (contract price) or $.50, whichever is greater 3. Postage and Handling (Only mail-in applications) $ 1.50 4. TOTAL PERMIT FEE • (Add lines 1-3 above) $ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted 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 installation are furnished 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. ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. 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 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: /4Y---,-------:- �L - Date: A-aA- op CREDENTIAL CERTIFICATION APPLICATION CITY OF ORONO 2790 Kelly Parkway, P.O. Box 66 Crystal Bay, MN 55323 Phone: 249-4600 Business: Xcl.:_f i/,,,' L�;, Phone: _ y 93 • <206 a .Same- (Business and Home) Address: /g5 a y 9 S ' (--/9,e City:/0/4p fdove_ State: /0//1/ Zip: SS 369 Type of License Held: Master Plumber J` House Mover Other . State License No. 3 8a6 pm ExpirationDate /d? - 3/a2 C 0 Have you ever had a license revoked? Af 6 When Where NOTE: The City does not have a special bond form to use. Proof of Workers Compensation insurance coverage is required for all contractors. Check kind of trade applying for: Septic Contractor (Required: MPCA Individual Sewage Treatment Systems License) House Mover (Required: $2,000 Bond, 10-50-100,000 Insurance) Mechanical (Required: $2,000 Bond, 10-50-100,000 Insurance) )c Plumber (Required: $2,000 Bond, 10-50-100,000 Insurance OR a copy of the State Plumbing Insurance/Bond) Municipal connections (sewer/water) Yes No Fire Sprinkler Installers (Required: $2,000 Bond, 10-50-100,000) Work shall not commence until this application has been approved and required permits are issued. Please indicate any other persons authorized by you to apply for permits: /Vô&e The undersigned hereby makes application to the City of Orono, Minnesota, for credential certification as indicated above, subject to the laws of the State of Minnesota and the Ordinances of the City of Orono. All applications are subject to a ten (10) day approval period. If disapproved, written notice will be sent. Signature: �i v Date: g - -- 0O Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system; (b)whether he may refuse oris legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82, subdivision 5,to a law enforcement officer. The commissioner of revenue may place the notice required under this subdivision in the individual income tax or property tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires,shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making, certifying, and compiling the copies. The responsible authority shall comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data, including recipients named by the individual;or(b) notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. )/'`C Jo 11 XR AS 2.—e- First Middle Last gas D-4i � -S 1/, Vt/ Address r, 16- GJti_ 55367 �,2- y�� -a©‘c) City State Zip Phone I understand my rights as stated above. • .401 S' re MINNESOTA DEPARTMENT OF HEALTH - BONDING AND INSURANCE CERTIFICATE This is to certify that Richard J. Kaliszewski master plumber License No. PM003826 representing Kal 's Plumbing Company Inc. has filed a $25,000 bond with the Secretary of State on December 8. 1999 and provided evidence of Public Liability Insurance, including Products Liability Insurance of at least $50,000 per person and $100,000 for the year 2000 in accordance with the provisions of Minnesota Statutes. Section 326.40 (1978) . BOND NO. 55-164004 Policy NO. 01-CD-255003-4 United Fire & Casualty Company American States Insurance Company Cedar Rapids, Iowa Cheryl Nessen, Minnesota Agent Minneapolis, Minnesota MR RICHARD J KALISZEWSKI KAL'S PLUMBING COMPANY INC. 7101 WEST PALMER LAKE DRIVE - `` e0.., _— BROOKLYN CENTER MN 55429 Patricia A. Bloomgren, Director Division of Environmental Health Jan K. Malcolm, Commissioner 2000 tate of inne.ota Olinne5ota J,_. cuartment of pealtb PLUMBING IT, BOX 6497 121 EAST SEVENTH PLACE, ST. PAUL, MN 55164-0975 Master Plumber License LICENSE NO 003826PM o: Richard J. Kaliszewski 12524 95th Place North Maple Grove, MN 55369 EFFECTIVE DATE EXPIRATION DATE 01/01/2000 12/31/2000 DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED J^ � PERMIT NO. � �' � � COMPLETED •=—z-3-CC) 2 -.c-k-) ADDRESS SSS IJV cLv' ��- OWNER CONTR. TELEPHONE NO. ' (c(-€4S L( DESCRIPTION LL! 01 FOOTING MECHA *RI 18 EXCAV/GRADING/FILLING Lt.cz 02 FRAMING MEC'• ' • FINAL 19 LAKESHORE/WETLANDS O 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 �077 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP DL+I 9 PWMBING RI=i 23 SEPTIC FINAL 35 HARD COVER REMOVAL 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL Z OWNER/CONTRACTO ME Y :_Y S_NO o COMMENTS: / /0'1(6- §12Dcve l.z_v e_ c2 c P - -fr•J-<(;,s O W Q Z W W cc • ^ • (% ORK SATISFACTORY:PROCEED I PROJECT COMPLETE CZ ORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY 0 BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. PHOTO TAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. 249-4600 Owner/Contractor on site: Inspector. 4, White Copy/Inspector's File Canary Copy/Site Notice