HomeMy WebLinkAbout2006-P10204 - vacuum breaker CI'TY �)F ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: P10204
Cryst�l Bay, Minnesota 55323 Permit Type: Vacuum Breaker
(952) 249-4600 Date Issued:
8/10/2006
SITE ADDRESS: 800 Forest Arms La Unit#
Mound,MN 55364
PID: 07-117-23-12-0004
DESCRIPTION:
Proposed Use: Residential
Permit Class: Plumbing
Permit Type: Vacuum Breaker Permit Sub-type(s): Vacuum Breaker
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
Misc. Fee: $ 1.50
TOTAL FEE: $ 37.00
APPLICANT: Weld&Sons Plumbing Company,Inc. OWNER: Robert&Janice Bonnema
3410 Kilmer Lane N 800 Forest Arms La
Plymouth,MN 55441 Mound MN 55364
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.
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APPLICANT PfRMITEE SIGNATURE IS UED E3Y SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reparts, 1-Assessing,(If Septic, 1-Septic) Page l
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FOR CITY USE ONLY
/i'"�j`�'1;,,,, City of Orono
/f� `y'\� P.O.Box 66 Date Received: Permit#
�{Q;r„ �" 2750 Kelley Parkway
�; �'h•" �+ Crystal Bay,MN 55323 Approved By: Amount$:
�� �;�'.�� (952)249-4600
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CITY OF ORONO-PLUMBING PERMIT
(All Commercial permits must be approved by the Building Official or Inspector)
GENERAL INFORMATION
I. You may apply for plumbing permits by mail or in person at the City offices. Applications will be
reviewed and a permit wili be issued within two working days.
2. Permit cards will be sent by retum 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 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 1
�Residential ❑Commercial(Approval Required)
❑New ❑Additional �Repairs ❑Replace
❑ In Accessory Structure?
*You will need arior approval and may need CUP.(Per Orono City Code,Chapter 78,Article IV)
Job Site/Owner Information:
Site Address: �U v r�;�{?,S.�.- ��-�� �,�,�
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Owner: I'>r e;�,-��; 4 :���-���� Mailing Address: �-�- !ti��ti?�'t�r wy,� �.
City: ����i,�c,�, M �.% Zip: _ �'J' �F�-f
Home Phone: Alternate Phone: (�/Z--S��-�i 7��
Contractor Information:
Contractor: W��� ;�.�L� �;�� j�l��r�,�>����� Contact Person: 1 )(1✓1 i�.��1�� �!'� �
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Address: �`��U ��(rw��.,e..-�h�� State Bond#: 5 -��U -�y�
City: � ��Ir�o;,�k� �Zip:S� ��( Expiration Date: � L���-v�,
Phone: �{i`�-�li i`�-�G'�L-��"' Alternate Phone: ��+;-��{-'���J�
Weld b Sons piumbin a- Insurance—Current: =��v�/� ; �Tnr-,
3410 Kiimer Lane No� 1
Piymouth� MN 55441
763-475-0296
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FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathroom Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous ,3
�'�S�Fa,t,l Ut,�C�u�,r�. br��Ker � �.G�✓� ��-+�'; a.-I-tv� .S�fS-f�enn ���� ��� �iS
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PER.MIT FEE CALCIILATIQN(S) � �
BASED OFF-2002 STATE'STATUE
❑ Yes,this section applies
The replacement of a 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;excludins the cost of the fiacture or appliance:and
3. Is improved,installed or replaced by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surcharge $ .50
Mail-In Fee(If Applicable) $ 1.50
Total Permit Fee $
(Permit Fees Continued On Next Page)
2
`" � ` :�� ,. :��.��LTLATION � F.:�.7{,�S C���i:`$5�}4.00
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If above does not apply;follow guidelines below:
I. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$35.00)
(U�Cac�o x.0125$ �����cJ
(contract price) (minimum$35.00)
2. STATE SURCHARGE **Add the State Bldg Code Div.Surchazge(Minimum Fee ofS.50)
�
_ J U�� v�% x.0005 $ '`7'�
(contract price) (minimum$ .50)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ _� 7•vU
• * 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 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.
• ** 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 Building Deparhnent at(952)249-4600 for the price.
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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�(,
. ���x� � ResB#FOrrrt ,��,
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3
� `� ��� DATE TIME
CITY OF ORON CALLED IN � '�'U
INSPECTION ��l��� SCHEDULED ���� •_�
PERMIT NO. U CO ETED
ADDRESS � S
OWNER CONTR. )�
TELEPHONE NO. � ' �S ' O��
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FR,4MING 13 MECHANICAL F AL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 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
W 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
�PLUMBING FINAL 36 FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORK SATISFACTORY:PROCEED I PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED r, ISSUE CERTIFICATE OF OCCUPANCY
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� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR W{LL RETURN
�CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call forthe next in pection 24 hours in advance. �95Z� Z49-4600
OwnerlContra r ' e
Inspector.
White Copyllnspector's File Canary CopylSite Notice