The URL can be used to link to this page

Home My WebLink About2000-P03095 (plumbing-fixtures) PERMIT Cl�TY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: Po3o9s Crystal Bay, Minnesota 55323 Permit Type: F�Xtures (612) 249-4600 Date Issued: lo�9i2oo SITE ADDRESS: 247o Carman St WAYZATA,MN 55391 P I D: 20-117-23-12-0060 DESCRIPTION: ._,_._.._, Pl'OpOSOC�USe: i�c�iucii�iai Permit Class: Plumbing Permit T e: Fixtures Permit Sub-type(s): Water Closet YP Lavatory Bathtub o�e�-- DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SU1I�MARY: Permit Fee: $ 35.00 Valuation: $ 2,500.00 State Surcharge Fee: $ 1.25 i i�i EiL r�:�;: � 36.25 APPLICANT: J.NORDSTROM PLUMBING OWNER: T A&D K LIND 4820 69TH AVENUE NORTH 38 ADDRESS UNASSIGNED BROOKLYN CENTER, MN 55429 MN 00000 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 BUII.DING CODE REQUIREMENTS. � ,�'==��_ c 1 �� G72�cz rt �✓� • AP T PERM[T E I NATURE [SSUED Y SIGNATi.JRE U`� Copies: City,Applicant,Assessor, Finance Page 1 Oct-O6-2000 OD:I'am From-CITY OF ORONO +g522494616 T-761 P.002/0�4 F-733 C1'TY OF ORON'O Al''P�,YCATION FOR PLiJ1��ING �IZMXT Box 66 (2750 Kelley Parkway) Crystal Bay, 112N 55323 �;NERAL IN��U�tMATION 1. You may agply far plumbing perruixs by raail or in person at the Ciry offices. 2. Permit cards will be sent by aetu:n mail �fter a rcview is oomplet4d. PERNiITS AR� NQT VAr,TI? UNTIL Y�U RECEIVE A PERMIT. woxx MuST NOT BEGnv �; 'I'IL THE PERMIT CARb IS �05TE17 ON ?HE.JO� SITE. 3. Plumbing permits may be issued ONLY ta licensed plumbine contractors and �o property owners residing in the dwzlling. 4. WhCn any new construction or re�odelin� is involved, a separace building persni[musc be 4btained. S. All work must be done in accordauce with thc State Code requiremtn:s. 6; All work�be inspected and air tested befare it is ca'vered. Call 249-46oQ. 24-hour notice requixed. Instru�tion� Complete ali items an chis appiicatior�, �o�pute the permit fee. Sign and dat� the certification. YNC4MPL.STE APPLdGATIC�NS WTT.�. NOT BE PROGESSET�. If you have qucstions, cal.l 249-�b00. Please check one: New � Addition Repair ___ _ Repl�ce _ C� Resadential Commercial JOB 5ITE: o�y� �/' . ' �F F � ZiP: Owner's Name: �o v bbrc �.;.-, Telephone Number: �`r-.i;�, _ L1 �l -7qc� Mailing Address: `��(� ,��1'.�►-��, 5�^r-: � CYty: NAV!t�''�� Zip: Contr�actor's Narne: � f�.;�c�c S 7�f,;��,-,_�L�;w��-�� Telephone NLuuber: 7�?-4(��'SS�� Ma31iIIg Addre�5s: tf ; C,_.�j`�1 _Y' ��'f /� � ity: !cc:►! � � C?� Zip: <-�. pLiJMBING �IX'�URE SCY�riULE FY'KT�.TRE BSMT 1ST 2ND OTH£R �FIXTURB BSMT 1ST 2ND C�TH�It TYPE Fl. FL TYPE FL FI. Water Closet �j � Flaor Drains I„av�tory �j`�� 8ewer Ejecror B2t�[ub '�;i,l(- Laundry Tray Shower ��i` Washer Kitchen Sink Wscer Heater Disposa] 1rJater Softenez T3ishwasher Wet Bar Siilcocks Misc (list) Oct-06-2000 00:18zm Fram{ITY OF ORONO +pg2Zq94616 T-751 P.003/004 F-T33 �'�12MIT 1^EE CALCULATIO�i 1. 1.25% of Contr�� * or �mum Fee� 35.OQ� �,r�==+� x A125 $ (contract pricc) 2, St$te Surchar�e. '"* Add Che State Building Codc Divisian SUxcharge to eac]z permit. x .0045 $ (contracc prlce) or $,50, whichever is greater 3. Pastaee and ndling (Only mail-in applications) $ _1.5_ 4. TOTAL PFR.NITI' �'� (Add lines 1-3 above) $ * CONTR.ACT�'R1Cfi or JOB C05T meaas the actual or c,stima�ed dollar amaun�charged far thc permitted work including materiats, tabor, pro�it, �nd other fixed costs. It is the amnc�t to ba charged to the customrr for the worlc done. If any mataxi�l, equipment, labor,or iustaliatian ue furn�st�d by tl�e owner, tenant or any otber parry the reasonable market value of such i�ems must be added co the esci�nated cast or cor.traet pxiee for perrnic fee purpose�s. In the event thaz[herc is a dispute an che amouut of�he job oost, the Ciry may request the submission of�si�ned c�py of the actual coptract, �"' "fhe STA'T� SURCHARGB is .D005 8f the contract prica under $1,�,000 or $.SQ - whichzver is gteater. For valuat�ns over $1.(�0,000 tal: thc Depamnent of Ybspectional Services Yor the priee. The undersigaed hereby app�iss to th;e City for issuanco of a Plumbing Permi�, agrees to do all work in strict aceordance with chc ordinances o� the City and the regulations of rhe State of Mianesota, and certifics that a1I statements made on this application are complete, tn�e a�d correct. Applicant's Signature: ✓� Date: �� , FRi7M : .JhJOP,DtiTRUhiPLiJt�1BI!JG FHX FJO. : 76.}5�9Et��'j prt. �1E� ct��p pb:2bP�"l P1 MIN,tiESOTA a£PI�r�TMENT OF h+FALi}� - 30N�INC AND Ii�SURANCE CERTIr?�IiTE Tnis is ';G C2C't1Ty �ha'C J1V R. �Ot'dst�om r�as_er� plumber Licer�s� PJc. f�hiUG3=�i]. re;r�esentir; J �dords�ror� Plum�in� has f•i1�=Ci r $?�.nOC �o��d ��tfi tne Secretary �r Sta�r: or�E �)ar'�tary 25. 20�0: ai�� rro�Yided e��id2nce c�t E'ur�l�c Li�bi-' � tY Irss�.�r�nce ��t'r� i;m?�s of at le�� $5J.000 �p� p�r,��r. �"_�'�J.000 �:er ��tcurr�nc�, :r.� �1��.�JCi� �rc�per�� arac,e f;;� ��;e vear ?�D�� r. ��cor_a�;ce u��n �}�e pi'G"d1,iC�fS Ot �t'i�Cl�'SO�d SLB�<it�5. 5��1011 �C'.7.-�� i.1�I$} . hONC{ �`,�. �3:�0658 Pol��y �1C. Q34�J39�, t'2C�i'o�e�a M:�t'�;�� nSu!"d!'iC? �Of�l�cl�';y Federa�2�I Nuivai LriSLI;"u�n(:C C0�!�nry �d��c8. Mt�;'12SC�La +�.� �,[1'fc�.XJ�C�. 1��I�r�2�G�d Ag2n� �watc��rra. i`gi rn?sot� ?4R J�'� D NORDSI'cOM ��;r�c��a(,�T�or� ��u�s��c �.� I� q�'I A, (� d oi-+t 4t'�.L�� lJJ��f M4.�IYUE IVUK I� � $rcOt�K.L'f��l CEti i cR Mti 55�G� . Fa�r?�i� �. �':��omgrer�, �irEc�o; pi v-�sion �f �'nvi ron^�e:zt�l Nea1�r� � ,}an ti_ «a�:,alm. worrm�ission�r �i��,tE !3� ��tTlit£SD�� ;'�ittne�u�a ��a��}ne�r a� ��ezl:� , P'LU?i�Il�G Ui�I.'�, 843� 6�#g75 1��. �� wr7�H 2�� SS� l�pl�r � Mas�ar Pl.r�ex Lic2ns� �c"�sE �a o_�a��1rM ��62`: �� S� 2'EST� � � ��: Jay D. Noxdstx�m �iFECTiVi DA7E EXPIRAItO'� ��T`- ��!9x�� zr3��a� . , � MINNESOTA DEPARTMENT OF HEALTH - BONDING AND INSURANCE CERTIFICATE This is to certify that Jay D. Nordstromle�sae$2P� OOOebondcwith the Se��etary representing J Nordstrom Plumbing has f of State on January 25. 2000: and provided evidersonof$POO�OOOLpebloccurrence, Insurance with 1imits of at least $50.000 per p and �10 .000 property damage f��SthSection2326.�0 (197gdance with the provisions of M�r�nesota Statu BOND N0. 9330658 Policy N0. 9340395 Federated Mutual Insurance Company Federated Mutual Insurance Company Owatonna , Minnesota Al Annexstad. Minnesota Agent Owatonna , Minnesota MR JAY D NORDSTROM � . ��e 8,.,,�--- J NORDSTROM PLUMBING .�-- 4820 69TH AVENUE NORTH BROOKLYN CENTER MN 55429 patricia A. Bloomgren. Director Oivision of Environmental Health Jan K. Malcolm, Commissioner i __.__ _ � Oct-O6-2000 �D:18�m From-CITY OP ORONO +95224�4616 T-761 P.004/004 F-'33 PROO�' OF 'WOR.�RS' C4MPENSATI�N Il`S�3R�.'�CE COVERAG� Min,nesota Statutc Section 1.76.182 requires every state a.nd local licensing agency to withhotd the issuance or renswal of a Iicense or permit to operate a business in 3�Sin�esota until the applicant presents acceptable evidence af complianee wich t�ie wor�ters' compensarion in.surance � coverage requirement af Sectian 176.181, Subd. 2, 'T'he �nformation requued is; The name of the 's.nsurance company, the policy numb�r, and datas of coverage or tkie pe�mit to sclf-insure. This information will be eollected by che liccnsing agency and put in their couipany file. It r;vill be furni;hcd, upon request, to the Department of Y.,abor and Indusuy w check for cornpliance with Minnesota Statute Sec. 176.181, Subd. 2. This informatian is requued by law, and ticenses and permits to o�eratc a business may not be issued or renewed if it is not Qrovided andlor is falsely reported. �rthcrmore, if this information is not provided and/or falsely roported, it ma� resul[ in a $1,000 penalty assessed against thc applicant by the Commissioner af the Deparcment of Labor and Yndusuy payable to the Special Compensation Pund. Provide the infornsation specified above in die spaces provided, �r certify the precise reason yotu business is excluded fiom complia�ce�vith the it�surance coverage requirement for warkexs' compensation. 3rLsurance Comgany Nam�; (1VOT the insurance agent; Policy Number or Self-Insurance l�ermit Number: Dates of Covenge: ` � O�t I am noc reqL'u•ed co have Warkers' compensation liability c�verage because: (� � have na employees covcred by the law. ( ) Och..-r (Speci�y) I�TAVE R�AD AND'(IND�STAND MY RTCrHTS AND OB�IQATIONS WiTH REGAR�S Td BU'SINESS I.ICENS�S, PERMITS AIvD �VORKERS' COVLPENSATYON C�VERACsB, �1p Y Gp,'FtTIFy THAT THE INF TI�N PROVIDED IS "I'RUE ANn CORRECT. (� � j�1 �6 " �� ma�, csigaamrc) ' /�}�^l s i!' e�� 1�,�-,1�►�-. �76 3 -- 5�0 - 55�� ` ' (Busiaess Pharx Numbc�) (CompaaY) DATE ZIME . CITYOFORONO CALLEDIN G'�Z� � Y� INSPECTION NOT�ICE�/� SCHEDULED /U /3-l�� " CG PERMIT NO. �l"i� COMPLETED `� l� ADDRESS ��'��Q C 0.�r�'�'�� f`• OWNER CONTR. �''�4�� 'G�S�� TELEPHONE NO. ��C% —J � DESCRIPTION l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS � O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL � 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 Q/0'�"� - NAL 15 SEPTIC INSTALL. 22 FOLLOW-UP ?L09 PLUMBING RI j 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING AL 36 FOUNDATION/REMOVAL Q OWNERICONTRACTOR TO MEET YOU:_YES_NO Z � COMMENTS: � r `" / L�tJ�-� � �u� i lil ' a � `� � � � l� o - � � 0 � W � Q � z W � W � � d r L NORKSATISFACTORY:PROCEED - PROJECTCOMPLETE W � ❑ CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O Cl CORRECT WORK,CALL FOR REINSPECTION TEMPORARY 0 BEFORE COVERING PERMANENT ❑ CORRECT UNSAFE CONDITION WITHIN HOURS. i- PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Call for the next inspection 24 hours in advance. 249-46�� OwnerlContractor on site: Inspector� G��'�-C��-c�11 � White Copyllnspector's File Canary CopylSile Notice DATE TIME CITY OF ORONO CALLEO IN /C��, /o�, $� �g�m INSPECTION NOTICE �j SCHEDULED l� a o ��r�. PERMIT NO. �� /� COMPLETED � � ADDRESS o�� n C��/�� `5f��t OWNER L-� � CONTR. ��'�'�'�-��'' C�nQ7' TELEPHONE NO. �GIC� ""3�� f ��' ""��9� � DESCRIPTION �� '�L� � �� S (-�, lV 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS Q 03 INSULA 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 J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � � `- J O � � O � W � Q � Z W � W � � d W ��NORKSATISFACTORY:PROCEED � PROJECTCOMPLETE �❑CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REWSPEGTION TEMPOFJARY � BEFORECOVERING PERMANENT ❑ CORRECT UtJSAFE CONDITION WITHIN HOURS. pHOTO TAKEN INSPECTOR WILL RETURN ❑ STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. 249-46�� OwnedContract i Inspector. ` Wh e Copylinspector's File Canary CopylSite Notice D�A�T1E..� TIME CITY OF ORONO CALLED IN LD"L�7 CCFL� �n '+-t� INSPECTION TI�E SCHEDULED t a"2'S"C3� 3'� PERMIT NO. coMP�ErEo � ` G` ADDRESS ��7 .Cr/ C�"'m�� - OWNER CONTR. � ` N��'C� f�IC� TELEPHONE NO. ��c1"' �31� � DESCRIPTION l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADWG/FILLING � 02 FRAMING 13 MECHANICAL 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 v 07 L 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 LUMBING FINAL 36 FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � w � � � O � � O � W � Q � Z W � W � j W/�rWORKSATISFACTORY:PROCEED [ PROJECTCOMPLETE �� W ❑ CORRECT WORK&PROCEED ISSUE CERTIFICATE OF OCCUPANCY O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT C CORRECT UNSAFE CONDITION WITHIN HOURS. pHOTO TAKEN INSPECTOR WILL RETURN C'STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED Cl INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Cali for the next inspecti 24 hours in advance. 249-460� OwnerlContractor on it • Inspector. White Copyllnspector's File Canary CopylSite Notice