The URL can be used to link to this page

Home My WebLink About2016-01112 - plumbing � -� CITY OF ORONO * z 0 1 6 - 0 1 1 1 z * 2750 KELLEY PARKWAY DATE ISSUED: 09/12/2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 425 LAKEVIEW PKWY PIN : 06-117-23-32-0004 LEGAL DESC : LAKEVIEW OF ORONO : LOT 1 BLOCK 1 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : FIXTURE NOTE: BACKFLOW DEV[CE-RPZ VALUATION OF PLUMBING 500 APPLICANT PLUMBING FIXTURE FEE 50.00 STATE SURCHARGE PLBG(VALUATION) 0.25 BINZ PLUMBING TOTAL 50.25 18164 LUEDKE LANE PRIOR LAKE, MN 55372- Payment(s) CREDIT CARD 1264 50.25 (952)212-4636 Minnesota State License#:plbg-PC644109 OWNER Source Land Development Inc. 18215 45TH AVE N STE D PLYMOUTH,MN 55446- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable Ciry 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 pennit will expire and become null and void if construction authorized is not commenced within l80 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 applican ' esponsible for assuring all required inspections are requested' co ormance with the State Building Code.This permit may be revoked a any ime for due cause. . - v I �� 9 � � /� � z Appl' a t Pe tee Signa re Date Issued ignature Date ' � � �p� City of Orono FOR CITY USE ONLY O P.O. Box 66 Date Received: 2750 Kelley Parkway Crystal Bay, MN 55323 Permit#' � c.� (952)249-4600—Main �t1kfSHOQ'�' (952)249-4616—Fax Approved By: Amount$: CITY OF ORONO — PLUMBING PERMIT (All Commercial Permits Must be Approved by the State Prior to City Approval) http://www.dli mn qov/CCLDIPDF/pe plumbplanrevapu pdf GENERAL INFORMATION 1. You may apply for plumbing permits by mail or in person at the City offices. Applications will be reviewed and a permit will be issued within two working days. 2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property owners residing in the dwelling. 4. When any new construction or remodeling is involved, a separate building permit must be obtained. 5. All work must be done in accordance with State Code requirements. 6. All work must be inspected and air tested before it is covered. Call (952) 249-4600. (24-48 hour notice required) ;TYPE OF PERMIT(Check AlI That Apply) � �esidential ❑ Commercial (Approval Required) Backflow Devi . �� ❑ New ❑ Additional ❑ Repairs ❑ Replace ❑ In Accessory Structure? *You will need arior aaaroval and may need CUP. (Per Orono City Code, Chapter 78, Article IV) Job Site/ Owner Information: Site Address: Z LG v•� rJ a...r�v�r�,�- Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: �J � •�h Contact Person: �C fc.m �l�l �L Address: �� b� �V�e a� ��-, State Bond #: City: ��-a� La. L, _ n'1 N Z� � 1� p: � 3�2 Expiration Date: Phone: �S^ 2-� 2"1 Z " �(� �� Alternate Phone: ❑ Insurance— Current: Page 1 x i- , to- • .. .�,. � ' �� :L�IJ,l�1l �l„1aIG� w:iX`Tl:1RES,=$EI�1C�.��1�`.�T',AL,L��.� ` �� . �.: � �� ,, � � .�, � FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 1sT 2ND OTHER TypE Floor Floor TYPE Floor Floor Water Closet Floor Drains Lavatory Sewer Ejector Bathtub Laundry Tray Shower Washer Kitchen Sink Water Heater Disposal Water Softener Dishwasher Wet Bar Sillcocks Miscellaneous , 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.00) •�' �� x .0125 $ (contract price) (mmimum $50.00) 2. STATE SURCHARGE x .0005 $ (contract price) 3. POSTAGE 8 HANDLING (Only on Mail-In Applications) $ 2.00 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 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. �.,, ��. ��III,T�.�1��L.iCA �,.�1�� - F�'��"��} �� .�, .� The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in strict accordance with the ord' nces of the City and the regulations of the State of Minnesota, and certifies that all statements ma e n this application are complete, true and correct. Applicant's Signature: Date: � �2 6 Building Official/ Inspector: Date: Page 2 � � � : � American Society of Sanitary Engineerin � Reduced Pressure Principle Backflow Preventer (RP) Fc � ASSE Standard#1013 Field Test Report F/�j . � e�ti� 7 F � ��.:��er of Property C ' ��;- ,� ,=.�dress Z. Lc� c�c i,,� O � ```� a�� State Zip Code � � �ccupant of Property (if different from owner) . �c�upant Address • ^�� , � "�� State Zip Code : ',��nufacturer of Device: (� �` ^�, S M4d�el#: /7� k� � S;ze of Device: C�' Serial#: `i ZS Z��V '� _oca"tion of AsCT�embly and Equipmp'(nt or System Application: Si D�' � �v�� Vl 1 •ii(�� 1 � ��Yl L��_CL��f a[\ i � �\ V � ■ -es� Equipment: ; t�;lanufacturer. Model#: �O-Z.Q(,Z-- ��,U Seria�#: Q�-IIG"��72.+ s C�libration Date: U ' . W�11 p�� ' Date test was performed: �z 1 Time test was erFormed: "'��11�h� � E P '� Static Line Pressure: r � ' ; Check Valve#2 Shutoff valve#2 Check Valve#1 Pressure Differential � Relief Valve ; ' � Leaking ( ) Z-7 ' i lnitial Test Leaking ( } Leaking O Closed Tight � s ; I Closed Tight,� Closed Tight J�j Pressure Drop Across Opened at_psid � � t � Check Valve#1 sid � ' � ; � � Describe parts 1�7,�Z i � and repairs i � ' ! when needed � Leaking ( ) � ' '' Finat Test Leaking ( ) Leaking � � Ciosed Tight ( } � � Closed Ti ht Pressure Drop Across Opened at_psid M . { � g O Closed Tight O Check Valve#1 psid , ; F i Certified Tester(print) J�ttrn7 w �l�Z Assembly Finaf Test ; Address ��\Ly �.�`�� Performance � � � City_ �.�' �%+�_ Stat 11/� Zip S�S�� Phone#: ��2-Z�Z L.� ��_ Pass ' � License#: ln � Certification# Z8�`16 � � i Fail ❑ � Signature ` Date: �'! �2 : i Comments or Recommendations (continue to other side,if needed): � � � � � � � Go.u-Co�rnection Cartrol Profe.rrional Orra/ificatia�t Stanrlard �� _-�SSE Series 5000-2009 i