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CITY OF ORONO PERMIT NO.: 2009-0020�
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 05/06/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 2640 KELLY AVE
PIN : 20-117-23-14-0006
LEGAL DESC : APPLE HILL
: LOT 008 BLOCK 001
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURES-MULTIPLE
NOTE:
1 TOLIET, 1 SINK, 1 SHOWER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
VOLKMAR,JOHN&SHERRY STATE SURCHARGE PLBG(<$500) 0.50
2640 KELLY AVE
EXCELSIOR,MN 55331 MAIL-IN FEE 2.00
TOTAL 17.50
OWNER
VOLKMAR,JOHN&SHERRY
2640 KELLY AVE
EXCELSIOR,MN 55331
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
Sta[e Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires sepazate
permiu. All provisions of laws and ordinances goveming 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 all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applic�ermitee Signa Date Is ed By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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Rpr '30 09 06: 1Op John Volkmar 952-471 -3155 p. 2
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r;y'Y. . Cryot�!Bsy.MN 55393 Apprwed BY_ Amount S:��, — l,lY�(E SS
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CITY OF ORONO—PI.UMBYNG PERMIT
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ENERAL INFORMATiON
]. You may apply for plumbing pecmits by mail or in pexson at the City offices. Applice4ions wi11 be
reviewed and a peimit will be issued within two worlcing days.
2. Permit cards will be sent by reUua mail af�er a n�view is oomplete�l. PERMIT3 ARE NOT
VALID UNi�.YOU RECEIVE A PERMIT• WORK 1VNST NOT BEGII�i i1NTII.THE
PERMlT CARD IS POSTED ON THE JOB S1TE-
3. Plumbing permits may be issued ONLY to licensed plumbiag oontractors aad to properiy owaers
rasiding in the dwelling.
4, Whm any new consavcdon or remodeling is involvod,a separate building permit must be
obtained.
5. All work must be done in sccordance with State Code r8quirements.
6. All work must be iosp�c�d aa�d air testsd before it is oovered. Call(952)249-4600.
(24-48 hour notice requYre� .
TYPE OF PERMIT
Check All That A t
Q Residential ❑Commercial(Approval Reqtured)
❑New ❑Additional ❑RePairs �RePlace
❑ In Accessory Stn�chue?
•You will need nriot aoaroval and may need_ .(Per Orono City Code,Chapter 78,Article IV)
ob Site/Owner Information:
Site Address: 2�Keliy Av
Owner: �ohn volkmar 1Vlail;ng Address: 2saa iceny a�,
Ci ���sior, MN Zlp: 55331
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Home Phone: �952)471-8744 ���phone: (612)508-2006
Cantractor Informstion:
Contractor:
Myself Contact Person: John Volkmar
Address: Staxe Bond#:
Ciiy: Zip: Expiration Date:
Phone: Alternate Phone:
❑ Insurance—C►�rre,nt:
1
Flpr '3b 09 06: 11p John Volkmar 952-471 -3155 p. 3
PLUMBING FTXTURES BEING IN5TALLED
� 'rURE 83MT 1 2 OTHER FIXTURE BSMT 1 2 OTf-�R
ypg FI, FI, . TYPE FL FL
ater CloL � ��r�s
�7 vT
av8tory � � Sawer Ejector
ni} Sin
� I,auudry Trey
hower � Washer
' hen Sink W�'H�'�T
•y.pp� Wat,c['Softener
'shweshet Wet Bas
illcocks M�e�O�
PERMIT FEE CALCL�I.ATION(S)
BASED OFF-2002 STATE STATUE
Ycss,this section applies
replacement of a Residential lixhue or suoliance that meeis all tl�ree of lh�following raquiremcnts:
1. �naquine modification to electrical or gas seivice.
� 2. Has a total cost of$500.00 a�less;e c ' the cost of ihe fixnue or appliance:and
3. Is improved,installe�or replaced by the homoowaer or licensed contractor.
Skip next section,if this applies; Cost of Perntit $ ]5.00
State Surcharge $ .50
• Mail In Fee(If Applicable) $ 2.00
Total Permit Fee ��
(Pcrmit Fees Coatinned On Nest Page)
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�
Rpr '30 09 06: 11p John Volkmar 952-471-3155 p. 4
PERNIIT FEE CALCULATION S -JOB5 OVER$500.00
above does not apply;follow guidelines below:
1. CONTRAGT PRICE •is 1.25%of coat=act price with a(Minimum Fee of$50.00)
x.0125$
• (con4ul pri�x) (miaimum 550.00)
Z. 3TATE SURCHARGE **Add.the State Bldg Code Div.Surcharge(Mioim�Fee of 5.50)
x.0005 $
(coptrad price) (minim�m►S .50)
3. POSTAGE 8t HAI�TDLING(Only on Mail In Applications) � 2•�
4. TOTAI.PERMlT FEE(Add Lines 1-3 Above) $
* CONTRACT PRICE or JOB COST meaas tbe acbual or estimated dollar amount charged for the
permit�tted work including materiels,tabor,profit,and other�ed costs.: It is tka�aimouut to be charged,
to t6e customer for the worlc done. If any maferial,equiPment,labor or installacions are fvmished by
the owner,tenant or.a�uy other party,the reasooable matket value of such items must be added to the
� estimated cost or conhact price for peimit 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 actaal contract
'*The STATE SURCHARGE is.0005 of the contract price undcr$1,000,000 or$.50-whichever is
greater. For valuations over$1,000,000 call the Building DeparOmeat at(952)249-'4600 for the price.
PLLJMBING PERMIT APPLICATION AGREEMENT �
The undersigned hereby applies to t�e City for issuance of a Plumbing Permit, agnees to do all
work in strict:accordance.with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that aJl statements made on this application are complete, true and
correct.
`.' /� .j �, � �� ��
APPlic�t's Sig.nature: v. Date: `t,^'
Reset Form
. . . 3
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DATE TIME
CITY OF ORONO CALLED IN /
INSPECTION NOTIC SCHEDULED 9 /D.'DD
PERMIT NO. O '�b�co PLETED
ADDRESS � �`6 �G�-f�
OWNER CONTR.
TELEPHON E NO. v��'/f�l !/D< ��4� ���' ��8-���
� DESCRIPTION 7 `� (�• �
� ❑ FOOTING p MECHANICAL ❑ EXCAV/GRADING/FILLING
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORENVETLANDS
y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE
Q ❑ TREE REMOVAL
Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION
Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
� ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
_ �'J PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEEf YOU:�YES_NO
y COMMENTS:
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� I�VORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W RRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITNIN HOURS. p pHOTOTAKEN
INSPECTOR WFLL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
�INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 4 hours in advance. (952) 249-46��
OwnerlContractor on site•
Inspector.
White Copyllospector's File Canary CopylSfte Notice
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DATE TIME
CITY OF ORONO CALLED IN ��,���
INSPECTION NO/T�yIC�E �,��n SCHEDULED �r`iG� _l,Q�
PERMIT NO. �K,Q -��'IJ�COMPLETED �� � �
ADDRESS .�
OWNER;��I U(�I �'�YY�� CONTR.
TELEPHONE NO. �I c�- —�G� —Z.DC��D
� DESCRIPTION � UL �1 � ^ I
� ❑ FOOTING � MECHANICAL RI ❑ EXCAV/GRADING/FILLING
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORENVETLANDS
y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE
O ❑ TREE REMOVAL
Z ❑ WALL BD. ❑ WATER HOOK-UP 0 SITE INSPECTION
Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS
� � DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
Q ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
_ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PIUMBING FINAL ❑ FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:�YES_NO
� COMMENTS:
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ORK SATISFACTORY:PROCEED ROJ ECT COM PLETE
W ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
O ❑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 REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
OwnerlContract o ' �:
Inspector.
White Copyllnspector's File Canary CopylSite Notice