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Home My WebLink About2004-P07638 - plumbing w PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway - PO Box 66 P07638 Crystal Bay, Minnesota 55323 Permit Type: FiXcures (952) 249-4600 Date Issued: 6i24i2ooa SITE ADDRESS: 65 Cygnet Pl I.ong Lake,NIN 55356 P I D: 04-117-23-22-0008 DESCRIPTION: Proposed Use: Permit Class: Plumbing Permit Type: Fixtures Permit Sub-type(s): Multiple Fixtures DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: PernutFee: $ 314.38 Valuation: $ 25,150.00 State Surcharge Fee: $ 12.58 Misc.Fee: $ 1.50 TOTAL FEE: $ 328.46 APPLICANT: Richfield Plumbing Co. Inc. QWNER: Kevin&Michelle Krokzyk 8640 Harriet Ave S-Suite#100 65 Cygnet Pl Bloomington, MN 55420 Long Lake,MN 55356 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 BUILDING CODE REQUIREMENTS. R L `� wr� APPLICANT PERMITEE SIGNATURE SUED BY SIGNATURE Conies: 1-File(SiQnitures Required), 1-Applicant 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1 CITY OF ORONO APPLICATION FOR PLUMBING PERMIT Box 66 (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 cards will be sent by rehirn mail after a review is completed. PERM[TS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3. Phimbin�; 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 worlc must be done in accordance with the State Code requirements. 6. All worl< must he inspected and air tested before it is covered. Call (952) 249-4600. 24-hour notice required. Instructions Complete all items on this application. Compute the permit fee. Sign and date the certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call (952) 249-4600. Please check one: /l New Additioi� Repair Replace Residential Commercial JOB SITE:_ (Q�j c�4� �1�,�, _Zip: --- Owner's Name: " Telephone Number: Mailing Address: City: Zip: Contractor's Name: j� '.�Id. PIUYY�"Jl�l.(/ Telephone Number:��g'��-3�5 Mailing Address: �(��{.Q �}Q,Y��.Q�- �}1/�.S. ��DD City: l0orni/1 � Zip: ��2c� PLUMBING FIXTURE SCHEDULE FIXTURE BS�1�1T 1 ST 2ND OTHER FIXTURE BSM 1 S 2ND OTHER TYPE FL FL TYPE T T FL FL Water Closct Z-- Floor Drains � Lavatory � � Sewer E'ector Bathtub � Law�drv Tray � Shower � � Washer � Kitchen Sinl< � Water Heater � Dis�osal Water Softener Dishwasher � Wet Bar Sillcocks � Misc list PERMIT FEE CALCULATION(S) 2002 State Statute ❑ Yes, This Section Applies The replacement of a Residential fixture or a�pliance that meets all three of the following requirements: I) Does not require modification to electrical or gas service. 2) Nas a total cost of $500.00 or less; excludin� the cost of the fixture or appliance: and 3) Is improved, installed or replaced by the homeowner or licenced contractor. SI<ip next section; Cost of Permit $ 15.00 State Surcharge $ .50 Mail [n Fee $ 1 .50 ------------------------------------------------------------------------------ If above does not apply, follow guidelines below: 1 . Contract Price* is .0125 �% of job �vith a Minimum Fee of ($35.00Z �� S► �SO • �� x .0125 $ � �3� (contract price) (minimum$35.00) 2. State Surchar�e. ** Add the State Building Code Division a (Minimum Fee of $ .50) � as, �sb .� X .��05 � ia . 5 �' (contract price) (minimum $ .50) 3. Postage and Handling (Only mail-in applications) $ 1 .50 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3 oZ�•�' �.0 �� CONTRACT PR10E or JOB COST means tl�e actual or estimated dollar amount charged for the permitted work including materiafs, 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 installation 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 tl�at thcre is a dispute on the amount of the job cost, the City may request the submission of a sianed 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 Inspection Services for the price. 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 th� application are complete, true and correct. Applicanfs Si;;n��ture: � (�- Date: �Z , :o Reset Form �� .� , . _. __.__.__ - --- ____. ._ , ., ---- � -- _- --_ ._—._ - , , � . -- _- , . _._ ,._--.___ �-.–----. - ____�_ -- - � � ; :; ; , MINNESOTA DEPARTMENT OF HEALTN - BOND CERTIFICATE ` '� � , , � � - ' ; i i ;� ! �. + �, + � � Tn�� s �o cer�i ��i �hat David F. Adelmann, Master Plumber License ; ; j ; � �� No. PM0025o8 , representing Richfield Plumbing Co. a Corp has iiled �a �25,000 = �� ' � , ! � ;� bond ��vi�h the Secretary of State on November 13, 2003 for the year 2004 in ! ; i � ;;il accordance wi�h the provisions of Minnesota Statutes , Section 326.40 . � " , ,, , � � � : i� l ♦ 1 � i i i : . t I ,, I � . � ' �i � I ' :�i BCND y0. 9��Obi� ' . , , , ; :� � Federated Muzual Insurance Company ; ; � ' � � 1 :;�� Owator,na , Mi nnesota ; ; : ; � "� ' ! ! � i; ' ' , IJ� 1 ' � �?; ; MR DAVID F ADELMANN ; ��:` � RICHFiELD PLUMBING C0. A CORP �; - � —=7�aoM ; ; � � :.; ; 86�0 HARRIET AVENUE SOUTH, SUITE I00 �'``'� ; ; ij ;,,; BLOOMINGTON MN 5�420 Patricia A. Bloomgren. Director � ; � ) , ��"°� Division of Environmentai Health " ' , ; j{ ; 11 i � � Dianne Mandernach . 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P--' � �_ ..�. -,�,,, . - . .. �.. _...+-_ae��._ ,�L-�«v- - EFFE£��fIEE FI'ATE _ ,��; ��'"=y- � �EJCP'1 �,EMfF� - ;'OI/2.0�4.'. - � �:�31,(�0�'�-'-`': , � � � ,� � � � � kD TIME � CITY OF ORONO '�_ CALLED IN V�� INSPECTION N T C SCHEDULED , -� � PERMIT NO. 3 COMPLETED ADDRESS [o-J c��S� �� OWNER CONTR. K-C c.n�"1 E�cf ��L� TELEPHONE NO. !�J Z O �� .3� � DESCRIPTION 1"'(�•� "�l �r'�-"� L� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS ti Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 07 DEMO-FiNAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUM Cti8 23 SEPTIC FINAL 35 HARD COVER REMOVAL v 1 PLUMBING FINAL 36 FOUNDATION/REMOVAL � ICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W C � �Z; ` �'.. 0 � � 0 � W � Q � z W � W � � d W WORKSATISFACTORY:PROCEED f I PROJECTCOMPLETE � ❑ CORRECT WORK&PROCEED I ISSUE CERTIFICATE OF OCCUPANCY W � ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. �; pH0T0 TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �� CITATION ISSUED ❑ INSPECTION REOUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� 249-46QQ OwnerlCont 'te: Inspector. White Copyllnspector's File Canary CopylSite Notice J DATE � TIME CITY OF ORONO CALLED IN INSPECTION NO ICE SCHEDULED 7-2Q-(3 _S1� PERMIT NO. �C� '�C,Q�J� COMPLETED ADDRESS � ��- OWNER CONTR. `� ' TELEPHONENO. �� 0 6 � �� DESCRIPTION �-��4� ;2s1,�� ly� 01 FOOTING 11 MECHANIC L RI 18 EXCAV/GRADING/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 OS FINAL 14 SEWER HOOK-UP 06 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J �NG FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: W a U ��ct � J O � � o C�S �' � S � W � Q � Z W � W � � d W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE � ❑CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY W � ❑ COFRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. �; pHOTO TAKEN INSPECTOR W4LL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CAIL INSPECTOR ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Call for the next nspection 24 hours in advance. (J52� 249-46�� OwnerlContra or 't : Inspector. White Copyllnspector's File Canary CopylSite Notice � A TIME � CITY OF ORONO �63� CALLED IN �� INSPECTION N � SCHEDULED -��-� c� ; 30 PERMIT NO. COMPLETED ADDRESS �5 OWNER CONTR. �-/C��l�� TELEPHONE NO. 9�Z- ��— 3.35� � DESCRIPTION �� l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING � 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 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT � 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBING Rt 23 SEPTIC FINAL 35 HARD COVER REMOVAL � 10 PIUMBING FINAL 36 FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO � CO�M�ENTS: e � � O � � O � W � Q � Z W � W � � d W _ WORK SATISFACTORY:PROCEED f I PROJECT COMPLETE � '❑ CORRECT WORK&PROCEED C' ISSUE CERTIFICATE OF OCCUPANCY W � ❑ 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 O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the� xt inspection 24 hours in advance. (952� 249-4600 OwnerlC or� site: Inspector. � White Copyllnspector's le Canary CopylSite Notice