HomeMy WebLinkAbout1997-009053 - irrigation backflow � PERMIT
' CITY OF ORONO PERMIT TYPE: -
2750 Kelley Parkway- P.O. Box 66 '-•`=` ''�<'- --
Permit Number: �:t��:'j:�:�'� .�`�`
Crystal Bay, Minnesota 55323 = ` - T
(612) 473-7357 Date Issued: _ _ _ _ .
SITE ADDRESS:
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DESCRIPTION:
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REMARKS: I
FEE SUMMARY:
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CONTRACTOR: �" ��`=!_'� �'=_��{��� OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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C1TY OF URONO APPLICATION FOR PLUMBING P�RMI'T
�ox h6 (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 cazds 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
POST�D ON THE JOB SITE.
3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property owners residing
F� 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 473-7357. 24-hour notice required.
Instructioii� Co:nplete all item� on this application. Compute the permit fee. Sign and date
the certificatioii. INC011��LET� APPLICATIONS WILL NOT BE PROCESSED. If you have
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questions, call 473-7357.
5
Please check one: New Addition Repair Replace
Residential Commercial
�' JOB SITE: :S,.s�S �'(�c 9� �:�-� 6�"n Zip:
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Owner's Name: � �,,�, Telephone Number:
Mailing Address: City: Zip:
� Contractor'sName: ��;���e�,,c� �`=a TelephoneNumber: �a-�--�,�
MailingA.ddress: �3�� ,�ti������ �/ City:�,,�,,�,,' Zip: 5�-���
� PLUMBING FIXTURE SCHEDULE
� FIXTUR.E 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
Dishw��sher Wet Baz
Sillcocks Misc (list)
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PERMIT FEE CALCULATION
1. 1.25% of Contract Price* or Minimum Fee ($35.00)
��� �.:� 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. Posta�e and Handlin� (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FE� (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, proft, 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 mazket value of such items must be added to the estimated cost
or contract price for pernut 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 Jnspectional Services for the price.
The undersigned hereby applies to the City for issuance of a Plurnbing 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.
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Applicant's Signature: Date: lv�� �
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MINNESOTA DEPARTMENT OF HEALTH - BONDING AND INSURANCE CERTIFICATE
This is to certify that Tony U. Sunderland master plumber License No. PM004212
representing Sunderland Plumbing has filed a $2,000 bond with the Secretary of
State on November 13, 1996 and provided evidence of Public Liability
Insurance, including Products Liability Insurance of at least $50,000 per
person and $100,000 per occurrence and Property Damage Insurance of at least
$10,000 for the year 1997 in accordance with the provisions of Minnesota
Statutes, Section 326.40 (1978) .
I,
BOND N0. 9156775 POLICY N0. 9180654
Federated Mutual Insurance Company Federated Mutual Insurance Company
Owatonna , �;innesota Kirk Nelson, Minnesota Agent
Owatonna, Minnesota �,
�� i 1 • -I��C Cr�'1 .
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MR TONY V SUNDERLAND
SUNDERLAND PLUMBING Patricia A. Bloomgren. Director
24380 RIVER BANK LANE NW Division of Environmental Health
ISANTI MN 55040-
Anne M. Barry, Commissioner
�r�re of �ir�r�e�ot�
,�irtr�e�ota �ep�rttt�et�t ot �eartfj �
PLUP4BING UNIT, BOX 64975
121 EAST SEVENTH PLACE, ST. PAUL, MN 55164-0975
Master Plumber License
LICENSE NO 004212PM
��: Tony V. Sunderland
24380 Riverbank Lane
Isanti, MN 55040
EFFECTIVE DATE EXPIRATION DATE
1 01 97 12/31/97
DATE C�/ TIME
CITY OF ORONO CALLED IN �� ��' /
INSPECTION NOTICE SCHEDULED � ' S �
PERMIT N0. qf�� 3 COMPLETED
ADDRESS 3 �� ���
OWNER CONTR. �
TELEPHONE NO. l.`�7 3 � � ��.5�
� DESCRIPTION L�t l��'1 � ^ 2-
� 01 F�OTINd 11 MECHANICAL HI 18 EXCAV/GRADING/FILLING
y 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q
2 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEM�SITE 27 SEPTIC MAINT. 2t COMPLAINT
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W 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 P � 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� PLUMBING FINAL 28 CEDAR SHINGLES �FOUNDATION REMOVAL
Z OWNER R TO EET YOU: YES NO
� COMMENTS:
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�d ❑WORK SATISFACTORY:PROCEED
_ PROJECT COMPLETE
W ❑CORRECT WORK 8 PROCEED C: ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. -, pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR -: CITATION ISSUED
C] INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
OwnerlContracto ��
Inspector. �
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