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Home My WebLink About2003-P06660 - plumbing PERMIT C��Y �F ORONO Permit Number: 2750 Kelley Parkway - PO Box 66 P06660 Crystal Bay, Minnesota 55323 Permit Type: FiX�res (952) 249-4600 Date Issued: s�ia�2oo3 SITE ADDRESS: 2s3o Fox st Wayzata,MN 55391 PID: 04-117-23-41-0010 DESCRIPTION: Proposed Use: Kesidentiai Pernut Class: Plumbing Permit Type: Fixtures Permit Sub-type(s): Multiple Fixtures DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 298.75 Valuation: $ 23,900.00 State Surcharge Fee: $ ll.95 TOTAL FEE: $ 310.70 APPLICANT: Great West Mechanical OWNER: Julie Johnson 24067 165th St. 852 A Lake E St Big Lake,MN 55309 Wayzata,MN 55391 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE TI�REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA�UILDING CODE REQUIREMENTS. /_ ' - � APPLICANT PERMITEE SIGNATURE SSUED BY SIGNATURE Conies: 1-File(Si�nitures Required), 1-Anplicant, 1-Monthlv Reports, 1-Assessin�, 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 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 the State Code requirements. 6. All work must be 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: New Addition Repair Replace �Residential Commercial JOBSITE: �S��J �r�k Sfrttf Zip• S53`�1 Owner's Name: ��/1e ��,%t Td�',,Wsi„J Telephone Number: 6!2� $G�-.�g�� Mailing Address: �5��,� fox STr�•k City: Zip: Contractor'sName: UrPkf c,,,�,� r�►�r�k,�n',��L TelephoneNumber: ��;-�65-6:=y�" Mailing Address: Z yo G� /6's ;�t�� City: �,g� C,�,� Zip: 55?o q PLUMBING FIXTURE SCHEDULE FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER TYPE FL FL TYPE FL FL Water Closet L' � Floor Drains � � Lavato 3 �f Sewer E'ector Bathtub � � Laund Tra � Shower � Washer � � Kitchen Sink � Water Heater /� Dis osal Water Softener Dishwasher 1 Wet Bar � Sillcocks 3 Misc (list) . PERMIT FEE CALCULATION(S) 2002 State Statute ❑ Yes, This Section Applies The replacement of a Residential fixture or ap�liance 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; excludin� the cost of the fixture or appliance: and 3) Is improved, installed or replaced by the homeowner or licenced contractor. Skip next section; Cost of Permit $ 15.00 State Surcharge $ .50 Mail In Fee $ 1.50 If above does not apply, follow guidelines below: 1. Contract Price* is .0125 % of job with a Minimum Fee of ($35.001 �'�' v� x .0125 $ �-�, `3 (contract price) (minimum$35.00) 2. State Surchar�e. ** Add the State Building Code Division a (Minimum Fee of$ .50) 2 �� 6� x .0005 $ (contract price) (minimum $ .50) 3. Postage and Handling (Only mail-in applications) $ 1.50 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ * 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 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 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 Department of Inspection Services for the price. The undersigned hereby applies to the City for issuance of a Plumbing Pernut, agrees to do all work in strict accordance ith the ordi nces of the City and the regulations of the State of Minnesota, and certifies t at all statem ts made on this application are complete, true and correct. Applicant's Signature: C��' Date: �J/��3 . - CREDENTIAL CERTIFICATION APPLICATION CITY OF ORONO 2790 Kelly Parkway, P.O. Box 66 Crystal Bay, MN 55323 Phone: 249-4600 Business: ��,r�'�+ w.��+ �rr��n,�a� Phone: 7 6 _�-�� l��5— Address: � `�G�- i r' (Business and Home) /U a 5T1'QQ+ Ciry: �; n� L.l��k� state: (�'�,�J zip: 5 S 3 C� j Type of License Held: Master Plumber� House Mover Other . State License No. �c� ��,f3 �- A� ExpirationDate /�- 3/��p � Have you ever had a license revoked?� When Where NOT'E: The City does not have a special bond form to use. Proof of Workers Compensation insurance coverage is required for all contractors. Check kind of trade applying for: Septic Contractor (Required: MPCA Individual Sewage Treatment Systems License) House Mover (Required: $2,000 Bond, 10-50-100,000 Insurance) Mechanical (Required: $2,000 Bond, 10-50-1009000 Insurance) �_ Plumber (Required: $2,000 Bond, 10-50-100,000 Insurance OR a copy of the State Plumbing InsuranceBond) Municipal connections (sewer/water) Yes � No Fire Sprinkler Installers (Required: $2,000 Bond, 10-50-100,000) Work shall not commence until this application has been approved and required permits are issued. Please indicate any other persons authorized by you to apply for pernuts: d�.1��(. S,N� , �..�vlz-,1� �� ,��Z� � j��e„� 7��P��rt/C� � The undersigned hereby makes application to the City of Orono, Minnesota, for credential certification as indicated above, subject to the laws of the State of Minnesota and the Ordinances of the City of Orono. All applications are subject to a ten (10) day approval period. If disapproved, written notice w 1 be sent. Signature: , �� ` Date: D �� _�J - . � Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Informatio�required to be given individual. An individual asked to supp(y private or confidential data concerning himself shall be informed oF. (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system; (b) whether he may refuse or is legally required to supply the requested data; (c)any known consequence arising from his supplying or refusing to supply private or contidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82, subdivision 5,to a law enforcement officer. The commissioner of revenue mav olace the notice reouired under this subdivision in the individual income tax or orooertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidentiaL Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed of the content and meaning of that data. After an :ndividual has been shown the private data and informed of its meaning, the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this sec?ion is pending or additional data on the individual has been collected or created. The responsible authoriry shalt provide copies of the private or publi�data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authori7�shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Samrdays,Sundays and legal holidt:ys,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,exduding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data, including recipien[s named by the individual; or(b)notify the individual that he believes the data ro be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Sube'. 2, "Rights of subjects of data", we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. � �r r � h�� S�>��P�- ��-�e First r� Middle Last ��/ob 7 /� 5' ST�r�r" - �S� � C.�� dv ��o� 7� s-��-�a�� Ciry State Zip Phone I underst d my ri ts as stated above. ,, re � � DATE TIME CITY OF ORONO CAL ED IN Z/ U INSPECTION NO ICE CpCf�D�) SCHEDULED � � PERMIT N0. COMPLETED ADDRESS �� OWNER CONTR. '� TELEPHONE N0. ��o� ' QL' I �' ��D� /`��-�� DESCRIPTION _ �(�.t-L-/?ti..� � Ot FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 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 v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU: YES_NO � COMMENTS: � W � � � C�, U c �, 0 � � 0 � W � Q � z W � W � � a W WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CARRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITION WITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN O STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIFED.CALLTO ARRANGE ACCESS. Call for the n t inspection 24 hours in advance. (952� 249-46�� OwnerlCon o ite• Inspector. � � White Copyllnspector's Fi Canary CopylSite Notice �� I ,�i�� DATE TIME CITY OF ORONO CALLED IN '�3 INSPECTION NOTICE SCHEDULED � PERMIT NO. COMPLETED ADDRESS Z�� v � � OWNER CONTR. ��'lP'�_f L�.CO�-�- TELEPHONE N0. �� C� �C� . �-C'� � DESCRIPTION �l�rnbi� � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 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 OEMO-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 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNER/CONTRACTORTOMEETYOU�YES_NO � COMM NTS: 0. � � J O � � O k W � Q � 2 W � W � j a W� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALLINSPECTOR ❑INSPECTION REQUIRED.CALlTO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (952) 249-46�0 OwnerlContractor ite: Inspector. White Copyllnspector's File Canary Copy/Site Notice �� DATE � TIME CITY OF ORONO CALLED IN ��—/_3 INSPECTION NOTICE SCHEDULED //�5�-Q3 /:3a PERMIT NO. P�/��D COMPIETED ADDRESS �5.30 S� OWNER CONTR. TELEPHONE NO. l0�Z ��:U 7��0 7 i�G� � DESCRIPTION I'�U� ��r%'�S^� � � 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FIILING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS y 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 O6 PROGRESS � 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP � 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL � 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a j � O �' 1 � � � p - • � � � � � C�,' �'� � �� 5 � ✓S � Q � a W � � � � � d W ❑WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W/❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR W{LL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. I Call for the next in�pection 24 hours in advance. �95Z� Z49-46�0 OwnerlConU�rct r�on si : Inspector. r I White Copylinspector's File Canary CopylSite NoUce O-- �D^�AT�E'�' TIME � CITY OF ORONO CALLED IN � INSPECTION N IC SCHEDULED 5/7-O 3:3(7 PERMIT NO. � COMPLETED ADDRESS G��D �zX��"/ OWNER CONTR. �� TELEPHONE N0. �D� �- 6/g D f�5� � � DESCRIPTION /- ��'�� l� 01 FOOTING 11 MECHANICAL 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 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 RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL � 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: i Giv' 7j� i �J � � O a � O � W � Q ti Z W � W � j a W WORKSATISFACTORY:PROCEED [� PROJECTCOMPLETE � ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the ne t inspection 24 hours in advance. (g52) 249-4600 OwnerlContrac�r-p 'te: Inspector. White Copyllnspector's Fi e Canary CopylSite Notice