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Home My WebLink About2013-00770 - plumbing CITY OF ORONO * 2 PJ 1 3 - 0 0 7 7 0 * , 2750 KELLEY PARKWAY DATE ISSUED: 08/06/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : ]003 COX FARM RD PIN : 27-118-23-33-0014 LEGAL DESC : SHADOWOOD FARM : LOT 002 BLOCK 002 PERMIT TYPE : PLUMBING(<$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : FIXTURE NO"I'F,: PRESSURF?VACUi!M BREAKI?R FOR I,AWN IRRIGATION APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 MARK KUEBELBECK PLBG STATE SURCHARGE PLBG(<$500) 5.00 8516 34TH AVE N NEW HOPE, MN 55428- TOTAL 20.00 (763)227-4305 PAID WITH CC# 4556 OWNER HARTLEIN, DANIEL&JULIA 1003 COX FARM RD LONG LAKE, MN 55356 AGREEMENT AND SWORN STATEMENT Thc work for which this permit is issucd shall be performed according to thc approved plans and specifications,applicable City approvals,and the State Building Code. 'I'his permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified herein.'I�his permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commeneed. 7�he applicant is responsible for assuring al ui d inspections are requested in � nform pce with � B ' �ng Co e.This permit may bc v at� � e f d use � / ! '� l l �� O / C.OI � Ap licant Per tee Signature � Date Issued Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. �OR ITY USE ONLY City of Orono �j� /�ONO P.O.Box 66 Date Rece eciY' � Pcrmit# �Ul�— Q 0 �� 2750 Kcllcy Parkway Crystal Bay,MN 55323 Approvcd By: Amount$: �� (95Z)249-4600—Main y t (952)249-4616—Fax F � CiTY OF ORONO—PLUMBiNG PERMTT ��KES E�� (All Commercial Permits Must be Approved by the State Prior to City Approval) �_ i�tt�:/h��ww.dli.mn.�ov/CCLD/P[)Fi e lumb �lanre��a� . df 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 issucd 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 A 1 ❑ Residential ❑Commercial (Approval Required) � New ❑Additional ❑ Repairs ❑ Replace ❑ In Accessory Structure? *You will need prior approval and may need(,l,;f'. (Per Orono City Code,Chapter 78,Article IV) Job Site/Owner Information: Site Address: /DO 3 CO,�C �,AQ.c�L�r� Owner: �v �i � /-��12�N, Mailing Address: /G�3 Co')C .�4�o,w� F-d. City: 48�J�� Zip: �.o+'c 9 �d K� S.s.�-S� Home Phone: �.5�-�'�/6—s/ -�l,$' Alternate Phone: � Contractor Information: Contractor: � fi ��l� Contact Person: . � �'� e1� Address: gs�� 3�� State Bond#: �C ��i//9�� City: �� (� Zip:��{o1`) Expiration Date: /o� �/ — 2o/3 Phone: 7�-3�t�� 3C1S Alternate Phone: ❑ insurance—Current: ��'��£.�� 1 (Per�nit i�ees Continued On Nest Page) 7 PLUMBING FIXTURES BEING INSTALLED FIXTURE BSMT 1ST 2"D OTHER FIXTURE BSMT 1ST 2 ° 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 �fSSv�2� !Jl�C vU� �Q�d�tlL -�o�e- �t�.-��=Y�-�� .�.c�.. 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; excludine the cost of the fixture or appliance: and 3. Is improved, installed or replaced by the homeowner ar licensed plumbing contractor. Skip next section,if this applies; Cost of Permit $ I5.00 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 I.25%of contract price with a(Minimum Fee of$50.00) 3�5.� x .o12s � 5�.� (contract price) (minimum$50.00) 2. STATE SURCHARGE �.� x .0005 $ � ��5 (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ -y�5,� ■ * 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 otber 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 tliat there is a dispute on the amount of the job cost, the Ciry 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� Date: O ""l0 �� 3 � TIM E `� CITY OF ORONO ALLED IN INSPECTION NOTI E SCHEDULED PERMIT NO. I � 7� COMPLETED ADDRESS I DC�3 GCS�. �i�i�� OWNER TELEPHONE NO. CONTRACTOR /�CLYk- f�Ue�e��CX� a DESCRIPTION —' � � '' L.e-�f ❑ � ❑ FOOTING ❑ PLUMBING Ft SK� EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI p� �,jJGII�P�[] LAKESHORENVETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J O PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOH TO MEET YOU:_YES_NO � COMMENTS: � W C � � � � �> > ^�S �� 0 � W � Q � Z W � W � � � ❑WORK SATISFACTORY:PROCEED Q�ROJECT COMPLETE W ❑ CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY � ❑Ct�RRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALI INSPECTOR � CITATION ISSUED O INSPECTION REQUIRED.CAL�TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� 249-46�� OwnerlContractor on site: Inspector. P White Copyllnspector's Fiie Canary CopylSite Notice