The URL can be used to link to this page

Home My WebLink About2016-00911 - plumbing CITY OF ORONO * Z 0 1 6 - 0 PJ 9 1 1 * ' 2750 KELLEY PARKWAY DATE ISSUED: 08/02/2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2940 CASCO PO[NT RD PIN : 20-117-23-31-0035 LEGAL DESC : REG. LAND SURVEY NO.0461 : LOT 000 BLOCK 000 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WATER HEATER NOTE: REPLACE WATER HEATER VALUATION OF PLUMBING 1500 APPLICANT PLUMB[NG FIXTURE FEE 50.00 STATE SURCHARGE PLBG(VALUATION) 0.75 LEGACY MECHANICAL SERVICES MAIL-IN FEE 2.00 114 THOMAS CIRCLE#106 MONTICELLO, MN 55362- TOTAL 52.75 (763)314-0877 Payment(s) CREDIT CARD 1785 52J5 OWNER HANSON, SCOTT&LYNETTE 2940 CASCO PT 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 a11 required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. ` D ! �i �i�� Applicant Permitee Signature Date Issued Signature Date GS-O�-,,o; ° ��4� ; �5�2Y9w610 ;?632950654 # 2i 4 ��p� City of Orono ,, . ' �OR,cln'u op� Y , -E Q P.O.Box B6 .�l�ts Recefved '',' 2750 Kelley Perkway ' Crystal Bay.MN 55323 Permlt�#� ' ��/�—�`�/"�': �'��^� o� (952)249-4600—Main M�`�� , ' ' .� �. A re►ved„B : ��` (852y 249�616—Fax pP ,.-.' Y AI'C10Utlt$. °' CI7Y bF ORONQ- pLI�M�ING P�RMIT (All�pmrrrerc;lal Permlts Must be Approved by the$tate Prior to City Approval) http:l/www.dli.mn.s�ovICCLDIPDF/pe plumbplanrevapp.pdf ------ , ��N�RAL"t MATIC7, , �� '. ' ; , . -;:' ,� �;,.: �� .•.. . �; � �'n � �. �:'� . M I ,�.',��`�� t- t 1.�Z„ ( �w.._ 1. You may apply for pfumbing permits by mail or in persnn at the City�ff,ces_ Applications wlll be review�d and a permit wlll be Issued within two working days. 2. Pennit carcis will be sent by return mail after a review is campleted. PERMITS ARE NOT VALID UNTfL YOU RECEIVE A PEF2MIT. WQRK MU3T NOT BEGIN UNTIL THE PERMIT CARb fS PbSTED ON THE JOB SITE. 3. F'lumbing permits may be Issued UNLY to Ifcensed plumbing contractors and ta property awners residing in the dwelling. 4. When any new constructlon or remodeling is involved,a separate building permit must be ob#ained. 5. All work must be done in accordance wlth State Code requirements. 8. All woric must be inspected and air tested before iE is�cnnvered. Call {952)249-4600. (2A-48 hour notice required) _._�__ ,^, y, . . _ ______ . .______ ______ ___'_"__ . '_'-^��.�... ��1?�MIT�:Ghe�k�#N.TktatApP�Y) esidential ❑ Commercial (Approval Required) [T3ackflow De ' e:Q AVB ❑PVBJ ❑ New 0 Additional ❑ Repalrs eplace ❑ In Accassory 5tructure7 "You will need prlor apprnv�l and may need CUP. (Per Orono City Code, Chapter 78, Arkicle IV) Jab SIteJ Owner Infnrrnatlon: "'�.•'�; Site Address: � ��L��`�' Owner: � L � Vl.� �'! Mailing Address: c��: C��ar�.G---- z�p: �5��'1 � ,..__ Home Phone: �� f��t7 Alternate Phone; _ Contractor lnfarmation, �, � �. � •,.�..�: . �. Contractor I��"l1� � rson:��L-�'L�__. Address: �r7 ��(/t �f��d State Bond #: �"��`�'"-! `"� f�__ � City: C 0-------------------------------------------Zip� Expiration Date;�� Phone' l4��_ ��QD I � Altemate Phone: ❑ Insurance- Current: RaeB� 08-02-16; 13:47 ; 9522494616 ;7632950654 # 3/ 4 , • {A�,, �, .W. .• �• `_ u.aRMN w.�Jw-�. FIXTURE �SMT 1 2"D OTHER FIXTURE BSMT 13 2N° OTI-9�R TYP� Floor Floor TYPE Floo� Floor Water Closet Floor Drains Lavatory Sewer Ejectar Bathtub Laundry Tray Sh�wer Washer Kifichan Sink Water Meater Disposal Water Softener Dishwasher Wet Bar SIIICOCks Miscelianeous . ��;� , ,;., Gr �` �� ;�r� ; �� 11��".• h� ;.'P.,. 1. CON7RACY PRICE * is 125%of contract price with a (Mlnimum Fee of$50.00) � J�[�l�_ . x.0125 $ X.-� y (contract price) (minimum$50.00) 2. STATE SURCHARGE �,�Q..l"//J x .0005 $ � � � ------ (contract price) 3. Pb57AGE$ HANDLING (Only an Mail-In Applications) $ 2.00 4. TQTAL PERMIT�'EE (Ad� Lines 1-3 Abov�} $.__________�� } �� " GONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permil#ed work including materials, labor, profit, and other fixed costs. It is the ampunt ta be charged to the cus#omer for the worlc done. lf any material, equipmen#, labor or installations are fumished by the owner, tenant or any other party, the reasonabfe market value of such items must be added to the estimated cost or contract prlce for permlt fee purposes_ In the event that there is a dispute on the amount of the job cost, the City may request the submission of a signed copy of the actual Contract. ..., y rt , �.a '�'` L.��'tl - '' .. .,..._ �.i: „ . , � '„� � , . 7he undersigned hereby applies to the City for issuance of a Plumbing Permit, agreas to do all work in striCt aCCOrdanCe with the ordinances of th Clty and the regulations of the State pf Minnesot�, and eertifies that all statem�nt ade on#hi i tion are cornplete, true and correcf. Applicant's Sign • -�— Date: � 1�________ Buflding Official/Inspector:_-_----------------------------------------------------------- Date: P�9B� OS-02-'6; "��3� Gi ; 9522494616 ;7632950654 # 4/ 4 _�'�1 OP ID:MS ' � AC'ORO� CERTIFICATE OF LIAB�LI'TY INSURANCE DATE(M�lI�DM'Y1n �--r� os�oti2o�� THIS CERTIFICATE I$ I&SUEa pS A MATTER �F INFORMATION ONLY AND CONFERS NO RIGWT$ UPON THE CERTIFICATE HOLDER.TWI$ CERTIFICATE DOES NOT AFFIRMATNELY OR N�GATIVELY AMEND, FJCTEND dR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THI3 CERTIFICATE OF INSURANCE DOES NOT CQNSTITUTE A CON7t�ACT BETYVEEN THE 133UING INSl1RER(S), AUTHORIZED REPRESEPITATIVE 0!i PR�DUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if tho cartlflcate holdar fs an ADDITtONAL INSUR�b,the policy{iea) must b*�ndarsad. If SUBROGATION IS WAIVED,subJect to the terms and conditiona of tba poficy,cartaln pollcl�s may rsqulrs an sndoraament. A atatemem on this caMificata does not conT�r rights to the c�rtlflaats holder In Ilau ef such endprbement S� PRODUCER NAM�• .�BKE OIIII er Foster Whita Agancy,Inc. pHoNE Froc 114 Wast 3rd StrAAt •759-295-26'14 �N,•7B3-29:f-3010 Monticello,MN 55892 oA p�Sa; olin e pgter-W�11tO.COti1 Jaka Olinger � ER LEGAC� cusraMeR�o e: INBURER(8)AGFORDINO COVERABE NAIC N n�sur�� egacy e� en ca Servlces, IN811REqA Selective Insurance Co.ofAm �72572 LLC dba " Legacy Mechanlcal 8ervlces INSIIRER B: 114 Thomas Clrcle#706 IN9URER C: Mantieelld,MN 55362 INBUREfl D: INSURER E: INSUHEF F: COVERAGES CERTIFICATE NUMB�R: REVISION NUMBER: THIS IS TO CERTIFY THAT THE P�LIClES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY FERIQD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM dR CON6ITION OF ANY CON7RACT OR OTHER DOCUMENT WITIi RESPECT TO WHICH THIS CERTIFICATE MAY BE 188UED OR MAY PERTAIN, THE IN9URANCE AFFOR�ED BY TkE POLICIE8 DE9CRIBED HEREIN IS $UBJEGT TO ALL Tt1E TERMS, EXCLUSIONS AND CONDITIOPIS OF SUCH P4LICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAfMS. � p TYPE OF 1NSURANCE POLtGY NUM6ER MM7D MM1� �1MIT$ 4ENERAI.uABItiTY FACMOCCURRENCE $ 'I,000,00 A X COMMERCIAL 6ENEPAL 61A9fLiTY SY�7GM1SZ O6I1 OIZO76 O6/1OIZOIT p�MIBES Ee oeeurronee S �OO,OO CLAIMSMADQ n OCCUR MED EXP An one eaon) S b�� ' PER80NALRADVIN,IURY j ��OOO�OO — I _.... � 4ENERALAQpREpATE 6 �i��r0� OEN'l AGGREGIATE LIMIT APPLIES PEFt i PftODUGT9-GOMP/OP A6G S Z�OOO�OO �POUCY' X P I.QC '� s AuroMael��UBluTY COMBINED 81NGLE LIMIT a 1,000,00 � {Ea acGOeiK) A X nnv nuro 52176462 05/10/2016 06h 01201T 80DI6Y INJURY(Pei D9�&on) S AlL OWNED AIJTOS "'"" BODILY INJURY(Per auident) $ SCMEOULEO AUTOB PROPERTY OAMAGE kIREDAUTOs (PERACCiDENT) S NON�OWN6D AUT0.S $ � UMBRELLALUIS OCGUR I �EACYI OCCVRRENCE $ � E7[CE99 LtA6 ��p,IMS-AA0.DE . !AGGREGATE S DEDUGT79LE �' �' � .—.. _ ....__.....__ RETFNTI ON � WORI�itS COMPENSATION X WC STATU- OTH- ANO EMPL0IERB'LIA91LhY A MIYPROPRfET'OflIPARTNEPlE7(ECUTIYETa WCg��Z�� 06/90/2016 06/10I2017 p,L.EACHpC,CIDHNT a 1,000,00 OFFIC�EUMEMOEREXCLU06�i Y p�A - (MantlaEoryirtNX) , E,L.DIBEASE-EAEMPLOYE $ �rQO��d�� N e,dattnlle u0U0f 1 000 000 o�SCRIFTION OF OPERATIONE bYIOW E.L.PISFJ+s�•POLICY LfMfT S � � ----- ---------------------------------- OEBCRfPTICW dp t1PrRA710N8/LOCAllf1M81 VEii1CLES(A!laeh ACOoiD 101,AOOHlonsl Mma�Ka BchrQula,I�maro rpaav fs roqulrad) CERTIFICATE HOLDER CANCELLATION CITYORQ BHOULD ANY OF TWE ABOVE DESCRIBEO POLICIES SE CANCELLED 9EFORE GI of Orono TFSE EXPIRATION DATE 7HER�OF, N(7TICE WILL g� bELIVEREb IN tY ACCbRDANCE WRH THE POLICY PROVISION&. Qrpno,MI� au�rnowg�aePr�serrranve Jeke Olinger M �1989-2Q09 ACORD CORPORATfON. All rlghts reserved. ACORD 25(2D09/09) The ACORD name and logo are reglstered marks of ACORD