HomeMy WebLinkAbout2011-01505 - plumbing 1
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CITY OF ORONO PERMIT NO.: 2011-01505
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE IssuEn: 12/09/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 2240 NORTH SHORE DR
PIN : 10-117-23-32-0019
LEGAL DESC : UNPLATTED 10 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : COMMERCIAL-BUSINESS
CONSTRUCTION TYPE : FIXTURE
NOTE: REBUILD RPZ VALVE-COMMERCIAL
VALUATION OF PLUMBING 496
APPLICANT PLUMBING FIXTURE FEE 50.00
EGAN COMPANIES,INC. STATE SURCHARGE PLBG(VALUATION) 0.25
7625 BOONE AVENUE N
BROOKLYN PARK,MN 5542& MAIL-IN FEE 2.00
() TOTAL 52.25
OWNER
MINNESOTA,ART CENTER OF
2240 NORTH SHORE DR
WAYZATA,MN 55391-
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
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires sepazate
permits. All provisions of laws and ordinances governing 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 I80 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 c se.
` / l �' l // /Zi 9' i �/
Applicant Permitee Si ature Date Issue y ignature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
•.:.':FQ. U346:ONLY:'::.`,':,`; ,'..
� CityofOrnno ,:.;.; ;'�1:.:;;: .' ,': .:::..::.::: : :� S�J�
$' � P.O.Box 66 Dabe Received:; �ermii�l�� .;
�. , � 2750 Kalky Padcwsy '.::...... .. . .. ,... .::...:.;....
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aY�al BaY�MN 55323 Approved By,, ''��.Amount�:�.
� ��`� � � (952)249-46U0—Main �
(952)249-4616—Faz
CITY 4F ORONO-PLUMBING PERMIT
(All Commercial Permits Muat be Approved by the Sts�te Prior to City Approval)
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GENERALINFORM�'T�ON :,. ,, ..: . . . : ., :::: . : .::...::....:: : ....:.':;: ..::;; ::., :::::....;..:... .:...:. ;
1. You may apply for plumbing peimits by mail or in pars�n at the City offices. Applications will be
reviewed and a peimit will be issued within two working days.
2. Pesmit cards will be sent by return mail af�er a review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTYL THE
PERMiT C IS POSTED ON THE JOB�ITE.
3. Plumbing permfts may be issued ONLY to licensed plumbing contractors and to properiy owners
residing in the dwelling.
4. When any new construction or remodeling is fnvolval,a separate building pamit must be
obtainal.
5. All work must be done in accordance with State Code raquiremants.
6. All wo�ic must be inspected and air tested before it is covered. Call{952)249-4600.
(24-48 hour nutice require�
TYPE OF�ERMIT'.,`:: `,;.`.` :. ; .::':, :'. `'. :`::.;.' , ` , , ;°.
` Check All That A 1
❑Residential ❑Commercial(Approval Required}
❑New ❑Additional �Repairs ❑R�P1ace
❑ In Aceessory Structure?
'�You will�ced nrior suuroval and may naecl�.(Per Orono City Code,Chapter 78,Article I�
Jo.b Site 7 Owner Inforrnation:
SiteAddress: 2240 North Shore Drive
Owner:Minnetonka Ctr of Arts MailingAddtess: 2240 North Shore Drive
Cify: Minnetonka Zj�: 55391
Home Phone: Alternate Phane: 9 5 2-4 7 3-7 3 61
Contractor Information:
Contractor: Egan Company ContactPerson: Chris Fern
Address: 7 6 2 5 Boone Ave No Sffite Bond#: 19 0-017-0 7 9
City: Brooklyn Par}Q�p:55428 ExpirationDate: 07/O1/12
Phone: 7 6 3-5 4 4-4131 Alternate Phone: �6 3-5 91-5 5 7 2
❑ Insuran —Current:
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FIXTURB BSMT 1 2 OTHER FIX�URE BSMT 1 2 07�iER
TYPB FL FL TYPE FL FL
Water Closet Floor Drains
��ry Sewer Ejector
Bathtub ��*5'T�Y
Shower Wssher
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher �'�B�'
Sillcocks Miscellaneous (1) RP
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� Yes,this section applies
The replacement of only one R�si�en�A fixt��or anpl'�.rCP that meets all three of the following
requirements:
1. not require modi�ication W electrical or gas service.
2. Has a total cost of$500.00 or 1ess;exc ' ti�e cost of the fixture or appliance:and
3. Is improved,install�or replaced by the homoowner or licenszd plumbing contractor.
Skip next section,if this applies; Cost of Perniit S 15.00
State Surcharge $ 5.00
Mail-In Fce(If Applicable) � 2.00
Tots!Permit Fec $ 2 2 . 0 0
(Permlt Feea Continued On Nezt Yage)
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If above does not appty;follow guidelines below:
1. CONfRAC'T PRICE *is 1.25%of tract price with a(Minimam Fee of$30.00)
D� X.atzs s -rb , �
( � ��) c�a��sso.o4,
2. STATE SURCHARGE �t�.�
x.0005 $
(co�ct Price)
3. POSTAGfi 8t HANDL]NG(Only on Mail-In Applications) $ 2.00
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4. TOTAL P�RMIT FE�(Acid Lines 1-3 Above) S
■ * CONTRACT PRICE or JOB COST means the �ctual or estimated dollar amount charged for the
per�nitted work including materials,labor,profit,and other fixod costs. It is the amount to be charged
to the customer for the work dona. If any maurial,a�uipment,labor or insialladons are furnished by
the owner,tenant or any other party,the reasonable market value of such items must bc added to the
estimataf oost or cflntract price for permit fee purpos$s. In the event that ti�ere is a dispute on the
amount of the job cost,the City may request the submission of a signed copy of the actual contract. �
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The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all
work in strict accozdance with the ordinan.ces of the City and the regulations of thc State of ,
Minnesota, and certiSes that all statements made on this application are complete, true and
correct.
A licant's Si �ll"� D�; 11/21/11
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3 •
, 1�1/�5/2611 67: 27 7637672855 DALE BDCAN PAGE 04/04
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� skd�irto an Psnml�u Xap�^—�� ' . ' .
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-� � BACKF,LOW PREVE/VTER T,E'ST REPORT
_ fnstructions to Certified Testers: All information must be T ed or clea rinted In btack ink
SlTE AD�RESS: p ,� � Lt/� '�'tv�2fp.,$�'3 Y
OCCUPAN?': �," PHON�; � TEST'�AT�:
� s—
D�VICE MAKE/MOpEL; t�` b fr�' SIZE: t�
SERIAL NO.
�' .' DEVICE LOCATiON: ' �•. � .., ,�
. �
` SYST�M DEVICE
S�RVES: %�J/l c��. �, ,e,r•.-
� � CFIECK VALVE CHECK VALV�# pRES. DIF. PRES. DI� �
#� 2 ACROSS#1 WHEN RELlEF STRAIN�R
CHECK qp�N
EST B�FORE REPAIRS �EAKED ( ) LEAKED ( )
� C�OSEp ( ) CLOSED ( ) PSt �pgj NON
. CLND ( )
' FINALT�ST CLOSED ---•CL03ED ( ���PSj �r
�
L.
DESCRIBE
�REPAIR � "
Certification: � �
I�hereby ce�tify that the foregoing date to be correct and that the tested device is functfoning
within the limits of fhe standards. . '
F(R E: EGAN COMPANY ADDR�SS: 7625 BOONE AVE. NO. BROOK�YN PARK MN 55428
BY:�_<< „���,-,.���_7ESTER'S CERTiFICATION #�i„�,��� PHONE#: 763-595-4300
SIGNpTURe oF CER]'IFIE�TE&TER . � �� F�(#: 763-595-4346