HomeMy WebLinkAbout2017-00214 - plumbing � ' CITY OF ORONO * 2 0 1 7 — 0 0 2 1 4 *
2750 KELLEY PARKWAY DATE iSSUED: 03/07/2017
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 780 LAKEVIEW PKWY
PIN : 06-117-23-43-0021
LEGAL DESC : LAKEVIEW OF ORONO
: LOT 7 BLOCK 3
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURE
NOTE: (1)FLOOR DRAIN
VALUATION OF PLUMBING 1350
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.68
SABRE HEATING&AIR COND INC. MAIL-IN FEE 2.00
15535 MEDINA ROAD
PLYMOUTH,MN 55447- TOTAL 52.68
(763)473-2267 Payment(s)
Minnesota State License#: mech-MB3392,p1bg-PC645349 CREDIT CARD 9764 52.68
OWIVER
Gonyea Homes
780 LAKEVIEW PKWY
MOUNq MN 55364-
AGREEMENT AIYD 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 E3uilding 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 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 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 applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issued y ignature Date
03/0�/z017 TUE ia: a2 Fax 763 a73 8565 Sdbre He�ting y Air Cond f�00z/OOa
$�I i78E ONLY /
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���+�C (952)249-4600—Mnin
ak�� (7S2)249-461G—P'ax
CITY OF URONU —PLUMBING ��:+'�R1Vll'�,
(All CommErcia!PErmits Must be Approved by the State Prior lo City Approval)
I�tt ://w w dli�n�n. Uv/(:' '.��1)/NT?1�'/�e, I �ti�b unreti•a f. �df
GLN�RAL INFQRMATION
1. 'You may Apply£or plumbing pezmits by nnail or in person at the City offices. Applications wsll be
reviawed Rnd a permit will be i.ysued within two working days.
2. Permxt ca�ds will be sent by return mail after a review is completed, P�RMZ�'S I#RE NOT
VALT17 Y1NTII.,YOU'RLCENE A PERMIT. `�+ORK MUST NUT'T3�GTN YJN''Y'TT�'Y'�YE
P ED QN TI�JOB �
3, Plumbing perrnits may be issued ONF.Y tc�licensed plumbing contractors and to property owners
r�siding in the dwellin�,
4. 'Whon any new c4nstruction o�r re�nodaling is involved,a separate building permit must be
obtuined.
5. Atl work must bo dano in ac:cordxiu;o with State Cadc�roc�uiroments.
6. All work mu.rt be inspected and air test.ed before it.is cqvered. Call(952)249-4600.
(24-4R hour notice required)
T�S�'P�O�'1'ERMIT
Check A�1 Ti�at A 1
[�Rosidential Q Commercial(Approvai Required)
[]New �Additionaf ❑ltopairs p Replace
❑ In Access6�ry SUuciure7
#You rvfll need nrior Annroval and may neod CUP.(per Orono City Code,Chapte�-78,Article I�
�µJol�Site/nwner�nfonnation:
Szte Address: � SS O �,,,�;Q,V 1� �DUY�(�l�D�
Owner: Matling Address: ___ _
City: Zip:
Home Phone: Alt�rnate 1'l�o��.e:
ContracCor Informatiqn�
Contractor: ��,����� ContaCt Person: �j/,�,d��l
�
Address: 1�3�.��1d14U�. � StateDond#: PCI��S�_'�� ..
Cit�� Zip:�,y ExpiralianDate: I•�.•�1• ZQ��
Phoz�e: �V3•�}'�,�� Alternate Phone: . �L 3�Z,5 3��?�x
[� , Insurauce—Current:
1
03/07/2017 TUE 14: Q2 FAx 763 673 8565 6dbre xedting � Ai.r Cond �003/004
��dXTURE BSMT 1 2 0'THER FIX'TURE BSMT 1' 2 OIT•ll3Tt
TYPE FL Fi, `I'Y�E I+L 1�L
Water Clpset Floor Drtins � �
I.avatory Sower�jector
�athtub I,aundry Tr�y
Shower Wash�
Kitchm Sink Water He�ber
Aisposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous
� Yea,tfiis axtion applies
Thc roplacamant of only ono I�idcmtial fi�ct�rce or appliance that mee�s�ll three of the following
C�uiremente:
l. poes not require modi�cadon to olcctrical or gas scrvice.
2. Fias a�of$500.00 or lesa;exclvdine tha wst of ti�e fixCure or appliance;and
3. Is improvcd,installed or replaced by the hpm�v�n�er or lieensed plumbing cont�actoc
Skip next section,if this spplios; Cost of�ennit S_ 15,00
State 5urcharge S 5.00
Mail-In�ee(If Applicable) $ 2.00
Total Pe��miE�'ee S
(Permif�eea Cotttulued Un NestPagc)
z
03/07/2017 TUE 1a:�3 FAx 763 d73 8565 Ssbre xeating 6 Air Cond �OOa/OOa
If above does not apply;follow guidelines below:
1. �ONTRACT PRIC� *is I,25%of contract price with a(Minimum Fee af 550.0(1)
_ _�35o•bQ �.oizs� 5ano _
(COtlCrhot�)fiCb) (htiuimum$SO.pp)
2. TA CAARGr�,'
�S)�.___x.0005 5�..___!�
. (contraot price)
3. pOSTAGE&HANDLING(Only on Mail-In Applications) S_ 2,00
4. TQ'�AL PE�IVIIT FEE(Add Lines 1-3 Abovo) S '�'��.(p�j' ,_�,�,
� '" CON'�'J.tACT PRYCL or 70B COST meac�s the aetual or estimated dollar amount charged �or the
permitted work including materials,labor,profit,and other fxed costs. �t is the anc�ount to bo char�ed
� to tho cus�mer for t�e work done_ if any material,equipment,labor or installati�a are furuished by
I the owner,tenant or auy other party,tlie reasonablc markct vafue of such itmna must be added to the
eetimated eost or contruct price fot pont►it fee pwposea, In the event that there is a dispul�e on the
� am0unt o�F the job eos�,the City may request the submiasian af a signed copy of the aetve,l co�mract
'l�c unde�rsigned hereby applios to the City for issuecuce of a Plumbing Permit, agi�s to do a11
work in sirict accordance widi the ordinan.ces of the City aud the regulations of the StaLe of
Minnesot� and certif'ies that a11 stateqsetxts made on this application are complet,e, true and
correct,
Applicant'sSignature: � � Date: �•�� ���] �_
�
3
� � g�TE TIME �
CITY OF ORONO cnLLED IN ��2 - b—�7 �'
INSPECTION NOTICE SCHEDULED J —�D—I 7 ,/��
PERMIT NO. d — COMPLETEP
ADDRESS 7 �D e U1�G(� ��I
�NNER TELEPH NE NO.�P� `��3���
CONTRACTO � $ � � ��
� DESCRIPTION �` � ��a'�� �� �""`YI.
4~j ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
� ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
� ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
�U ❑AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
v ❑ DEMO-SITE ❑ SEPTIC INSTALL
2 O'WNERlCONTRACTOR TO MEEf 1FlOU:_YES_NO
� COMMENTS:
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W KSATISFACTORY:PROCEED ❑PROJECT COMPLETE
� ❑CORRECT WORK�PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
w
0 ❑CORRECT WORK�LL FOR REINSPECTION TEtiAPORARY
V BEFORE COMERING PERMANENT
O CORRECTUNSAFECONDITIONWITHIN HOURS. p pHpTOTAKEN
INSPECTOR WILL RETURN
❑STOP OROER POSTED.CALL INSPECTOR ��TATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca8 for the next inspection 24 hours in advanoe. (952) 249-4600
on s e:
Inspector: �`�l
WMte CopyAnspecMr's Fil� C�nary CopyfSits Norie�
a►re nME
CITY OF ORONO CALLED IN
INBPECTION NOTICE SCHEDULED
PERMR NO. a4�7"OD 2�1�/ P� e v �
ADDRESS
O�WNER TELEPHONE NO.
CONTRAC'fOR
�'' DESCRIPTION �� � �✓�'" `�`�`
❑ FOOTING ❑ DEMO- I ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAVKiRADIN(iIFILLIN(3
`f ❑ FOUNDATION WATERPROOF �IABINCa FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑COMPLAINT
� ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATIOWREMOVAL
_
r 0 DEMO-SRE ❑ SEPTIC INSTALL
� dWN�OMRACT'OR TO YEET VWl:_YES_NO
� COMMENTSc �
4 ��riol' I�!'Q,�r- �CJ� C�Qr�SG �
� ��.,r<<4llfi - �9/C
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� �Clw►.� �i/'t��Y
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� ❑WORK 3ATISFACTORY:PROCEED / WJECf COMPLETE
W ❑OORRECT W�ORIC a PROCEED ��ISSUE CERTIFlC/1TE OF OC�PMNCII
o ❑CORRECTYMOPo(.CALL FOR f�INSPECTION TEMPOMFiY
� ����� PEAMANB�IT
O OORFiECT UNSAFE OON01'►lON WITHIN HOURS. O PHOTO TAKEN
INSPEC7�OR WILL RETURN
O STiOP OfiDER P08TED.G1LL INSPECTOR O dTATiON ISSUED
❑INSPECT�N REQUIRED.CALL TO ARFiAN(iE ACCESS.
c,N�n,e��u no�m�o.. (952) 249-4600
on site:
�Q �w 'K - --
yy��p�Ana�elo�s Flb c.n.ry(�fdM.qoua
� _ �/
� ; IVED
� American Society of Sanitar.y Engineg�r�n�2o�1
Pressure Vacuum Breaker Assembly (PVB)
� ASSE Standard#1020_F.ie.id Test Report C�'�'y OF ORONO
� ' ° awner of Property t Vp c'�'b,���S� '
� Address � V. ���
�' �ity��rJ� S'�ate_� Zip Code
� '' �ccupant of Property(if different from owner)
�: Cccupant Address
� � City State Zip Code
� - ! �;�anufacturer of Device: �nf <.����S - Modei#: � � - �'
� - Size of Device:_l�' Serial#: C�Z�(aZ� `7�
; �ocation of Assembly and Equipment or System Application: S i t�� o � �v`��
�. c�`�ti �Qr-3
� x
; ; Test Equipment: 1
� � " P.lanufacturer: � ` Mode!#: ��- �cK��l 1�,� Serial#: ��C�O�Z I
; ;
; ` Calibration Date: ( 17
� ' '� Date test was performed: Time test was performed: 1��.� Static Line Pressure:
;
� � ! � Air Inlet Valve Check Valve Shut Off#2
�
� i
� Leaking ( )
� , N Faited to Open Closed Tight O Leaking { )
` Initial Test
� ' r Opened at psid Pressure Drop Across Closed Tight O
' { Check Valve#1 psid
� � }
; � Describe parts and
� � + repairs when needed
� �
� � Leaking ( )
Opened at o�_�g psid Closed Tight (✓}� Leaking ( )
� Final Test Pressure Drop Across Closed Tight (
� Check Valve#1 r.5 psid
� Certified Tester(print) CC.VY� 6 1�2 Assembly Final Test
Address ��fo Ue, � Perfo ce
� City n State Zip Pass
Phone#: �S'Z-ZIZ,-�(,(p3
� License#: C. Certification# S�� �v�'L(� Fail �
� Signature ' Date:���
! Comments or Recommendations(continue to other siae,if needed):
� �N��s C�sn , �..���.t_ L,.-,�f-c�
,
E
� Cro.rr-Connectio�i Control ProfesrionalQ�ralificationr Standar�! 77
� ==�3.SSE Serie.r 5000-2009