HomeMy WebLinkAbout2007-P11393 - vacuum breaker PERMIT
CITY OF ORONO
.2750 Keiley Parkway- PO Box 66 Permit Number: p11393
Crystal Bay, Minnesota 55323 Permit Type: VacuumBreaker
(952) 249-4600 Date Issued:
8/31/2007
SITE ADDRESS: 2240 North Shore Dr Unit#
Wayzata,MN 55391
P��� 10-117-23-32-0019
DESCRIPTION:
Proposed Use: Residential
Permit Class: Plutnbing
Permit Type:
Vacuum Breaker Pernut Sub-type(s): Vacuum Breaker
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
RPZ Rebuild
FEE SUMMARY: Permit Fee: $ 15.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
Misc.Fee: $ 1.50
TOTAL FEE: $ 17.00
APPLICANT: Egan Companies,Inc. OWNER: Art Center Of Minnesota
7625 Boone Avenue N 2240 North Shore Dr
Brooklyn Park,MN 55428 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE UED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
. ro►�crr�°usE o��v
040�0 City of Orono
P.O Bo�66 Date Received: Pcnnit#
, � 2750 Kelley Parl:w�ry
a � � ��� Crystal Bay,MN 55323 Approved By: Amount$:
:Ry �� c`�� (9�2)249-4600 �
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CITY OF 0120N0-PLUMBING PERMIT
(All Commercial permits must be approved by the 13uilding OFficial or Inspcctur)
GENERAL INFORMATtON
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 rivo workin�d1ys.
2. Permit cards will be sent by retlirn mail after a review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECENE n PERNIIT. WORK MUST NOT BEGIN UNTIL THE
PERI�IIT CARD IS POSTED ON 7 IIL JOB SITE.
3. Plumbine permits may be issued ONLY to licensed plumbing contractors and to property owners
residing in the dwelling.
4. When any!�ew construction or remodelin� is involved,a separate bui!dii�g permit musl be
obtained.
5. All worl<mList be done in accordance with State Code requirements.
6. All worl<must be inspected and air tested before it is covered. Call (952)249-4600.
(24-48 hour notice requirecl)
TYPE OF PERMIT
(Check All That A 1 )
❑ Residential �Commercial(Approval Required)
��
❑ New ❑ Additional �[J Repaiis ❑ Replace
/�
❑ ln Accessory Structure?
*You will need prior approval and may need CCiP,(Per Orono Ciry Code,Chapter 78,Article IV)
Job Site/ wner Information:
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Site Address: ������ ���,�� � ��� ���1C��i��(� ��1.
O�vnec: ��l � ���"-�'�C' �� Mailin� Address: �����
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c�ty: �ti��z�� zip: -�_�_� � l
Home Phone: Alternate Phone:
Contractor Information:
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Contractor: ��i� ����iC�� Coi�tact Person: ����
Address: �� " ��� ���`�f�� ��r1�tate Bond #: ���''-"��� �� ���� �
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City: i �l i i, , . � � Zip:�j� �r.�Expir�tion Date: '��-
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Phone: � ��f�" ����.�'�'�-' Alternate Phone:
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lnsurance urrent:
1
� PLUMBING PIhTURES BEING INSTALLED � �
FIXTURE BSM"I� I'� 2ND OTl-lER FIXTURE 13SMT IsT 2'�'° OTHER
TYPE FL FL TYPE FL FL
W ater Closet Floor Drains
Lavatory Sewer Ejector
Bathroom Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous / ���
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i�.���cr�C�
PERMIT FEC CALCULATION(S) � � � �
� BASED Of�'F - ?002 STATC STATUr ��
� Yes,this section applies
The replacement of a Residential fixture or ap�liance that meets all three of the followin�requirements:
1. Does not require moditication to electrical or gas service.
3. 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 contractor.
Skip iiext section, if this applies; Cost of Permit $ 1�.00
SCate Surcharge $ .50
Mail-In Fee(If Applicable) .---�-----t�SII��
Total Permit Fce $ /5, �j�J
(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 PRICG * is I?�%of coi�tract price with a(N[i�iimum Fee of$3�.00)
x .0125 $�-��
(contract price) � (minimum$35.00)
2. STATF SURCHARCE ** Add the State Bldg Code Diu�:Sw'charge(�liniiuum Pcc of�.SO)
x .0005 $
(contractpF�ice) (minimum$ _�0)
3. POSTAGE&HANDLING(Only on NJa�f1-In Applications) $ 1.50
4. TOTAL PliRlV11T FGG�ndd Lines I-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. lt 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 pwposes. In the event that there is a dispute on the
amount of the job cost, the City inay request the submission of a si�ned copy of the actual contract.
• k* The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or �.50—whichever is
;reater. �or valu�tions over$I,000,000 call the Quildin�Department at(9�2)249-4600 for the price.
�� � � � PLIIMBIN�G PERMIT ARPLICATION AGREEMENT� �
The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all
work in strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all statements made on this application are complete, true and
correct.
,
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Applicant'sSignature: �t� ���i� ,�i ���/� Date: ���,���
Reset Form
3
FROM : FAX N0. : Aug. 23 2007 04:59PM P3
�--_....,.,. �
' � � ' ' 7625 Boone nvonue Nocth
BrooY{yn Pdrk,Miv SSa28
Main 763.544.4131
� �1�.�d� Fax 763_595.�346
�n www.cgattcacoa�s
]kaa Compan.l'
BACIC�LOW Pf��YEIVTER 7"E 'T R�POR. .
��c�:� ' ' �inted in�lack k�c
instruohons�Csrtif�ad Tos�s: All Iniwmetbn must be Y d or dea
�K.os� ziP'
3fTE ADORESS: �
CCUPANT: ` PHON�: 't�ST DATE: P-�3�
e� �-s .
- s�z�: �.`� s�a�A�.No. �
DEVICE MAKE/MOt7E : m '
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, DEVICE�OCATION: �� .:��"�✓� � '' �
SYSTEM [?6VICE � (����
�HRV��: f'n Gc.��C. ,
CHE�K VAt,V� CHECK VALVE# � PaES. DIF. PR�S. DI�
#f , a ACROSS#i WHEN AEl.I�F STRAtNER
CH�G14 OPEN
L�AFCHD ( ) L�AKEQ( ) ��i �?9; NONE(�')"�
EST gEFORE REPAIRS CLOSED ( ) CLOSED( ) CI.ND ( )
FiNAL TEST C�.OSED CLOS� C���si �•�psi
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DE$4RiBE ' T- �� 00� �
REpA1A �
�K--�-ao Q� -- �. �
Csrtification:
1 hereby oeNfy that the toregoing dete to be conect and that the tested devic;e ia#unc'doniq�
withfn the(imlts of khe standsrda.
FIRM NAME: �GAN ME�H�N{��l. CQf�lTFiAC�T R�S__,�A�DRESS: ,7�25 gOON�AVE.NO_,,,_,_
g�C�� [�d•--- TES'�'ER'S CERTIFICATION # gd,,:o3�b3'�HpNE#: �fi3-59„�5-4�QQ
���a Companle�,lue. FA)(#' 76_�_,_3_59�..d�b�
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