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Home My WebLink About2012-00934 - gas line only � CITY OF ORONO * 2 0 1 2 - 0 0 9 3 4 * 2750 KELLEY PARKWAY DATE ISSUED: 03/06/2013 � ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3435 CRYSTAL BAY RD PIN : 17-117-23-43-0120 LEGAL DESC : WILEYS PARK LAKE MTKA : LOT 003 BLOCK 001 PERMIT TYPE : MECHANICAL(> $500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : GAS LiNE ONLY VALUATION : $ 800.00 APPLICANT MECHANICAL 50.00 BENJAMIN FRANKLIN PLUMBING STATE SURCHARGE MECH(VALUATION) 0.40 1424 3RD STREET N MINNEAPOLIS, MN 55411- TOTAL 50.40 (763)755-6468 OWNER BROWN, SCOTT 3435 CRYSTAL BAY RD WAYZATA, MN 55391- 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 S[ate Building Code.This permit may be revoked at any time for�lue cause. / / / / Applicant Permitee Signature Date Issued By ' nature ate SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. fi��-V�� r��' ��^� �� FOR CITY USE ONLY . /-"""��"��, City of Orono ,,�� ,O O�\ P.O.Box 66 Date Received: Permit# '�i ,�n, 2750 Kelley Parkway �` }�� - �� Crystal Bay,MN 55323 Approved By: Amount$: t��F� '��, (952)249-4600—Main ,.��;;. (952)249-4616—Fa�c CITY OF ORONO— PLUMBING PERMIT (All Commercial Permits Must be Approved by the State Prior to City Approval) htt�://��vw.clli.mn. c�r�/C'CLUIPL71+f c liim� lani-eva . df GENERAL INFORMATION l. 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 1vOT BEGIN UNTIL THE PERMIT CARD[S 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 A l ) ❑ Residential ❑ Commercial(Approval Required) ❑ New ❑ Additional ❑ Repairs ❑ Replace ❑ In Accessory Structure? *You will need arior aaaroval and may need CUP.(Per Orono City Code,Chapter 78,Article IV) Job Site/Owner Information: Site Address: �j�'� �`� �`�(�St�,L� �� . c, --� Owner: ��((,:;;� �(__�1��-%1rl Mailing Address: �-�� C L��_��C�� =t�-� �� "J��1 � City: ��(�(1(,% Zip: Home Phone: �%�� C�� '�`J Alternate Phone: Contractor Information: Contractor: ��(Z� ��CC�I,�I`�1��-(�-�'`�`�ContactPerson: �(�j�(1�•� ��-��--� r� -� Address: 1�� -�r� ��: � State Bond #: �_(S,�-}�� City: �11'�W�}�'C ' ��4�ip:5= �11 Expiration Date: �,�I-�1 �dbl .� Phone: �.Ll�� `-X�'�,�� A(ternate Phone: ��(�� c��<<S-��(�� ❑ Insurance—Current: (��'1�l' '`��,-�1,.,��--'��, 1 PLUMBING FIXTURES BEING INSTALLED FIXTURE BSMT 1 2N OTHER FIXTURE BSMT 1 2�' OTI-IER TYPE FL FL TYPE FL FL Water Closet Floor Drains Lavatory Sewer Ejector Bathtub Laundry Tray Shower Washer Kitchen Sink Water Heater Disposal Water Suftener Dishwasher Wet Bar Sillcocks Miscellaneous + I � PERMIT FEE CALCULATION(S) �� BASED OFF - 2002 STATE STATUE ❑ Yes,this section applies The replacement of only one Residential fixture or appliance that meets alf three of the following requirements: L Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excludin�the cost of the fix;ure 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-[n Fee(If Applicable) $ 2.00 Total Permit Fee $ (Permit Fees Continued On Next Page) 2 k3c�c� a ��e� �� o�Sdr� �. - , . ��_� ��--, � �; �, � ,� � �__�.�_,� �'�� PERMIT FEE CALCULATION(S -JOBS QVER 04.00 If above does not apply;follow guidelines below: 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) ��:JJ X.�125 $ ��-C�J (contract price) (minimum$50.00) 2. STATE SURCHARGE �' ��(-� � �� X.000s $ , y� (contract price) 3. POSTAGE&HANDLING(Only on Mail-[n Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � � � � I � ■ * CONTRACT PRICE or ,iOB COST means the actuai 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. [f 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: Date: ��c�j' �� I i Reset Form �I � 3 DATE TIME✓ CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO. �/�- � 93�r COMPLETED P��`1- /�1 ADDRESS �rr3 S Ci ys��L Gsy /�1 _ OWNER TELEPHONE NO. CONTRACTOR �1 O/►t•�. Fi�[.eL�/�n� ��f' - � DESCRIPTION G4'3 /i.t e- � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q O POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS y � FRAMING ❑ MECHANICAL FINAL Q ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ,�EOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS:�e�w�•t /Eo<,Pe� ��,/e,p � c4// �'vi 4 a ��H•e L �n s,oe.e��o.,... j � /tv 0 n e � kc r•�c�- � 0 ,,,[ � �` �'V 1 G l�j� �/O f r� G Q'F f l!�G ��' L�� O � W �� 1 � ��G4S< <O�tL�c�f !'o R��4 C�a/ �6 �C�raoeril,e. Q ZGt� t�5��ra r�. GJ�'�li� �. l0 ��S � W � W � j d W ❑WORK SATISFACTORY:PROCEED � PROJECT COMPLEfE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE CWERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL REfURN ❑STOP OfiDER POSTED.CALL INSPECTOR ❑CITATION ISSUED �ECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 2a hours in advance. (g52) 249-46�0 OwnerfContractor on site: Inspector. � �^- White Copyllnspector's Ffle Canary CopylSite Notice