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Home My WebLink About2012-00637 - water heater CITY OF ORONO * 2 0 1 2 - 0 0 6 3 7 * � 2750 KELLEY PARKWAY DATE ISSUED: 07/03/2012 , ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2555 FOX ST P[N : 04-117-23-44-0002 LEGAL DESC : AUDITOR'S SUBD. NO.229 : LOT O10 BLOCK 000 PERMIT TYPE : PLUMBING (>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WATER HEATER VALUATION OF PLUMBING 1500 APPLICANT PLUMB[NG FIXTURE FEE 50.00 LEGACY MECH SERVICES STATE SURCHARGE PLBG (VALUATION) 0.75 9714 WOODCREST CT MONT[CELLO, MN 55362- MAIL-[N FEE 2.00 (763)219-8978 TOTAL 52.75 OWNER ECKERLINE, MR.& MRS. 2555 FOX ST WAYZATA, MN 55391 AGREEMENT AND SWORN STATEMENT The work for�tihich this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant pennission for additional or related work which requires separate permits. All provisions of laws and ordinances govcrning[his[ype of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of� l80 days at any time afier work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance�vith thc State Building Code.This permit may be revoked at any time for due eause. `iT/�t1,L'C-� ��, l l ��^✓1��. - l l Applicant Permitee Signature Date Issued By gnature ate SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED A VE. FOR CITY USE ONLY � City of Orono ��¢ �� P_O.Box 66 Date Received: Permit# ��a:, �'� 2750 kellcy Parkway �/ y, �� h� Crystal Bay.MN 55323 Approved By: Amount$: �� ,h�iv�o� (952)249-4600—Main � �stxo�." (952)249-4616—Fax CITY OF ORONO — PLUMBING PERMIT (All Commercial Permits Must be Approved by the State Prior to City Approval) htt �://�c��.�lli.mn. o��ICCLD/NDF/ c lumb l.�nre��a >>. df 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 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 NOT BECIN 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 I ) ❑■ Residential ❑Commercial (Approval Required) ❑ New ❑ Additional ❑ Repairs ❑ Replace ❑ In Accessory Structure? *You will need prior approval and may need(_liP.(Per Orono City Code,Chapter 78,Article IV) Job Site/Owner Information: s;te Address: 2555 FOX STREET Owner:'4SHTON GRUDNOWSKI Mailing Address: 2555 FOX ST c�ty: ORONO 7ip: 55391 Home Phone: �612� 799-5048 Alternate Phone: Contractor tnformation: LEGACYMECHANICALSERVICES JAIME OR DUSTIN Contractor: Contact Person: 9710 WOODCREST CT PC644975 Address: State Bond #: MONTICELLO 55362 03/14/14 City: Zip: Expiration Date: Phone: (763� 3�4-0877 Alternate Phone: ❑ Insurance—Current: �� 3 1 �� OP ID: MS '`��R�� CERTIFICATE OF LIABILITY INSURANCE DATO7IOZI�2 Y� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 763-295-2614 CONTACT Foster,Carlson&White Agency PHONE Fnx 20o W edwy Po Box 188 763-295-3010 l�c,No,Ex��:-------- --_-_--_--- - - __ �i �nic,No�:_ Monticello,MN 55362 E-^^Ai� Mark White ADDRESS:__ _____ - PRODUCER LEGAC-3 CUSTOMER ID#: INSURER(S)AfFORDING COVERAGE NAIC# - - � - - - - - � -- - � � - --- - --- - - - - - - ----------- wsuReo Legacy Mechanical Services, wsuReRn:State Auto Insurance Companies 25127 LLC iNsuRER B:RAM Mutual Insurance Com an 16330 1236 Edmonson Ave NE P y--- - Monticello, MN 55362 iNsuaeR c: INSURER D: � INSURER E: � INSURER F: � COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. � � - - - INSR� 7ypE OF INSURANCE DOL UBR', pOLICY NUMBER �MM/DY/YYYY MM ODIYYYY LIMITS LTR � GENERAL LIABILITY i li �, � EACH OCCURRENCE 5 'I�OOO�OOO � DAMAGE T�RENTED -� - - A '� X � COMMERCIAL GENERAL LIABILITY � II BOP 2613875 li O6/10H 2 II 06/10/13 � pREMISES jEa_occurrence]___$ 300,�� - � ------- -- - - - - � I CLAIMS-MADE I_X�l OCCUR ', � �i �MED EXP(Any one person) $ . 5,00 �. � . PERSONAL&ADV INJURY $ 'I,OOO,OOO i � � � I �GENERALAGGREGATE $ Z,OOO,OOO h -- ' GEN'L AGGREGATE LIMIT APPLIES PER�. I PRODUCTS-COMP/OP AGG li $ � Z,OOO,OOO PRO- i_ . . � - - - � - � �� POLICY X � T � LOC i $ �,AUTOMOBILE LIABILITY I I i I COMBWED SINGLE LIMIT I � '��OOO,OOO , i i i '� li (Ea accident) ! A � X ANY AUTO BAP 2327914 06/27/12 ', Os/27/13 , i - I i i BODILY INJURY(Per person) $ � ALL OWNED AUTOS I � � � - �� --�-- �--------- - - - - BODILY INJURY(Peraccident) $ I SCHEDULED AUTOS II i I ---- � � � ---------� -- - - PROPERTY DAMAGE $ C . HIREDAUTOS (Peraccident) �I NON-OWNED AUTOS � $ � I -- ---------- ------ $-- - - - � - � UMBRELLA LIAB � i OCCUR EACH OCCURRENCE $ �- - � ---- � - --- . . _ -_ _ ! EXCESS LIAB � I !. CLAIMS-MADE AGGREGATE $ I- - - -- -------- I __ _ . _ __.- � - ------ i DEDUCTIBLE �I I i _ .. . . _ - $-_-_--_----_-- I � RETENTION $ ' $ I WORKERS COMPENSATION II I � � X WC STATU- OTH-� � AND EMPLOYERS'LIABILITY y�N �� , I I .__1TORY LIMITS_I__ I ER_�_____ ___ B I ANY PROPRIETOR/PARTNER/EXECUTIVE IWC 3OZZSO.00 I OBH O/'I Z �I 06/10/13 � E1.EACH ACCIDENT � $ 'I OO,OO I OFFICER/MEMBER EXCLUDED? �IIIN�A' � � i �- --- - � � � -1 - -- -- - - - - - - - (Mandatory in NH) � 'i i 'i E1.DISEASE=EA EMPLOYEEi 5 _ . 1��,�� If yes,describe under I ��. II i ! � � 5�0,�0 DESCRIPTION OF OPERATIONS below , E.L.DISEASE-POLICY LIMIT ' $ i �I li DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 107,Adtlitional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION CITYORO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI Of OfOf10 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ACCORDANCE WITH THE POLICY PROVISIONS. Orono, MN AUTHORIZED REPRESENTATIVE Mark White O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD PLUMBING FIXTURES BEING 1NSTALLED FIX�I'URE E3SM�1' I�� 2'D O'I�HER FIXTURE F3SMT I`� 2`D O�I�HER TYPE FL FL TYPE FL FL Water Closet Floor Drains Lavatory Sewer Ejector Bathtub Laundry Tray Shower W asher Kitchen Sink Water Heater X Disposal Water Softener Dishwasher Wet Bar Sillcocks Miscellaneous PERMIT FEE CALCULATION(S) BASED OFF - 2002 STATE STATUE ❑ Yes,this section applies The replacement of only one 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;excludin�the cost of the fixture 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-In Fee(If Applicable) $ 2.00 Total Permit Fee $ (Permit Fees Continued On Next Page) 2 PERMIT FEE CALCULATION S -JOBS OVER$500.00 If above does not apply; follow guidelines below: 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) 1 ,500.00 X .012s $ 50.00 (contract pricc) (minimum$50.00) 2. STATE SURCHARGE 1 ,5�0.�� .75 x.0005 $ (contract pricc) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines I-3 Above) $52.7� ■ * 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. PLUMBING PERMIT APPLICATION AGREEMENT The undersigned hereby applies to the City for issuan e of a Plumbing Permit, agrees to do all work in strict accordance with the ordinances of th ity and the regulations of the State of Minnesota, and ce ' s that all statemen made this application are complete, tr and correct. , Applicant's Si ture: Date: �� Reset Form 3