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HomeMy WebLinkAbout2013 - 00683 - water heater • CITY OF ORONO 11 I I III III II II 11111 III II 2750 KELLEY PARKWAY * 213 - 0E 3 — PPJ 6 2 3 DATE ISSUED:: 07/18/2013 ORONO, MN 553.56- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2485 WOODHAVEN DR PIN : 33-118-23-41-0017 LEGAL DESC : WOODHAVEN 3RD ADDN : LOT 002 BLOCK 001 PERMIT TYPE : PLUMBING(>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WATER HEATER VALUATION OF PLUMBING 1099 APPLICANT PLUMBING FIXTURE FEE 50.00 SEDCK HEATING&A/C STATE SURCHARGE PLBG(VALUATION) 0.55 1408 NORTHLAND NORTHLAND DR- SUITE 310 MENDOTA HEIGHTS,MN 55118- MAIL IN FEE 2.00 (952)881-9000 MISC FEE 0.00 TOTAL 52.55 OWNER WOLF, MARK 2485 WOODHAVEN DR LONG LAKE, MN 55356 AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. Applicant Permitee Si ature Date Issued By /nature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER HAN DESCRIBED ABO) . 4o4-ad' 55 ' FOR CITY USE ONLY O ,O CityPO ofBox O66rono Date Received: Permit# �/ 2750 Kelley Parkway Crystal Bay,MN 55323 Approved By: Amount$: (952)249-4600—Main (952)249-4616—Fax CITY OF ORONO—PLUMBING PERMIT (All Commercial Permits Must be Approved bythe State Prior to CityApproval) htt :I/www.dli.mn.rov/CCLD/PDF/ e lumb lanreva• .sdf GENERAL INFORMATION 1. You may apply for plumbing permits by mail or in person at the City offices. 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 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 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 Apply) Residential El Commercial(Approval Required) El New ❑Additional ['Repairs ❑Replace ❑ In Accessory Structure? *You will need prior approval and may need CUP.(Per Orono City Code,Chapter 78,Article IV) Job Site/Owner Information: Site Address: (--V%-i 5 OV eth Ov ►�1 �Y Owner: \A(1;1,1 . We 1 Mailing Address: a'1 �,� �'1 V�>n Y�� City: 1,61 L — Zip: fRW25S3' (p Home Phone: Alternate Phone: Contractor Informattion: Contractor: ;C)Q C()WA- (l-��1� Contact Person: 0,\1 (1 �!. 1 t Address: j 4 d Nw 10411v,• State Bond#: `s1\V O64 i 3 City: [J\{Vlak V1 Ll-psZip:`JSi Expiration Date: I 1104/ 11 Phone: 95;1- 1- el/6 Alternate Phone: ❑ Insurance—Current: 1 c , PLUMBING FIXTURES BEING INSTALLED FIXTURE BSMT lsr 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 Miscellaneous PERMIT FEE CALCULATION(S) BASED OFF —2002 STATE STATUE ❑ Yes,this section applies The replacement of only one Residential fixture or appliance that meets all three of the following requirements: 1. Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance:and 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. Skip next section,if this applies; Cost of Permit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ (Permit Fees Continued On Next Page) 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) /r q- x .0125 $ ,5C1 (contract price) (minimum$50.00) 2. STATE SURCHARGE logo 11-L) x.0005 $ .55 (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 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 installations 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. PLUMBING 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 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 rtAt/ �- ,�� lid Date: 1 3 ACCPREP CERTIFICATE OF LIABILITY INSURANCE DATED/Y 1 10/29//29/20122 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-952-358-7500 CONTACT Kim Hansen NAME: Arthur J. Gallagher Risk Management Services, Inc. PHONE 952-358-7522 FAX 952-358-7501 (A/C.No.Ext): (AIC,No): 3600 American Boulevard West E-MAIL ADDRESS: hansen@a ADDRESS: Y_ jg•com Suite 500 Bloomington, MN 55431 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: OHIO SECURITY INS CO 24082 INSURED INSURER B: OHIO CAS INS CO 24074 SHAC LLC dba Sedgwick Heating & Air Conditioning INSURER c: WEST AMER INS CO 44393 1408 Northland Drive INSURERD: Mendota Heights, MN 55120 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 29884938 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY BKS54885052 10/29/12 10/29/13 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 400,000 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 PRO- 7 POLICY X ECT X LOC $ A AUTOMOBILE LIABILITY BAS54885052 10/29/12 10/29/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS _ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) _ B X UMBRELLA LIAB X OCCUR US054885052 10/29/12 10/29/13 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$10,000 $ C WORKERS COMPENSATION XWW54885052 10/29/12 10/29/13 X WC LIMIT ER AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Orono THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2750 Kelley Parkway AUTHORIZED REPRESENTATIVE Orono, MN 55356 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD praveenminn 29884938 ler DATE TIME \/ \\ a� CITY OF ORONO CALLED IN _ INSPECTION NOTICECHEDULED t/)(81g(/'m •,3"0 PERMIT NO. Ota .(�Q(, COMPLETED ADDRESSA A 2 g U OO` o-,er J it- I , IOWNER citric UO I / TELEPHONE NO. LP1Z-27- 43. CONTRACTOR S ✓ f� '� � (� - # DESCRIPTION !/� �� - 9 ►il.LU W ❑ FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL Q ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING y ❑ FOUNDATION WATERPROOF 0 PLUMBING FINAL 0 TREE REMOVAL Z ❑ RADON SLAB 0 MECHANICAL RI 0 SITE INSPECTION Q 0 FRAMING 0 MECHANICAL FINAL 0 PROGRESS • ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT Q FIQIAL 0WATER HOOK-UP OLLOW-UP tAi ❑ AS BUILT-SURVEY 0 SEWER HOOK-UP 0 HARD COVER REMOVAL J % - ❑ P INSTALL 0 FOUNDATION/REMOVAL Z OWNERIC• RACTOR TO MEET YOU: YES NO v, i MMENTS: cc a 6iJste 1i�. s r¢�l�✓v 4.4.,...,e CC • o e,$e". ..-5 7S /%K cc - Cpci s IK.S 7. k C lY/.4 ,eYeNlcf - O W cc Q Lc / �a opleee — W Z W ccIQ ❑WORK SATISFACTORY:PROCEED PFREJI`CT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY C.1 BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN El CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. all for the next inspection 24 hours in advance. (952) 249-4600 Owner/ tractor on site: 717it 4),f--F Inspector. /►-.- White Copyllnspector's File Canary Copy/Site Notice DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO. PD/3'006 1.3 COMPLETED 6-3-'3"--- ADDRESS 07 e- Abad `iat.,.e.-. .C1 OWNER TELEPHONE NO. CONTRACTOR �' Jr�ar,c-k 16-7. /Cc DESCRIPTION k/tttcv- he•Ak t e.v ref/• W ❑ FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL Q ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING Q0 FOUNDATION WATERPROOF 0 PLUMBING FINAL 0 TREE REMOVAL ❑ RADON SLAB 0 MECHANICAL RI 0 SITE INSPECTION Q 0 FRAMING ❑ MECHANICAL FINAL 0 PROGRESS 0 INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT ▪ jgEJNAL 0 WATER HOOK-UP ,g.EDLLOW-UP ❑ AS BUILT-SURVEY 0 SEWER HOOK-UP 0 HARD COVER REMOVAL 0 DEMO-SITE 0 SEPTIC INSTALL 0 FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU: YES_NO v, COMMENTS: Q.• 4 r rw4C Ao lade✓ .�c�,/AO 35 C t !/ .6a✓ a o .f, i i- MOs ec6I0•,. o hD pn,e_ A 1 e_46/ OVohd -- C /14 t! 2 W Sr-4(6041e_ a -r r titre; SG a et:)tel. Or cc WG6% abty y�,�� !�o%i a W� ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE 111 ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY OO ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR CTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector{-/w— White Copy/Inspector's File Canary Copy/Site Notice