HomeMy WebLinkAbout2002-P05611 - plumbing ,
CI�`Y OF OR N PERMIT
� � Permit Number:
2750 Kelley Parkway- PO Box 66 P05611
Crystal Bay, Minnesota 55323 Permit Type: Fixtures
(952) 249-4600 Date Issued: 9/13/2002
SITE ADDRESS: 3440 North Shore Dr
Wayzata,MN 55391
PI D: 08-117-23-43-0019
DESCRIPTION:
Proposed Use: Kesidenrial
Pemut Class: Plumbing
Pernut Type: Fixtures Pernut Sub-type(s): Multiple Fixtures
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 100.00 Valuation: $ 8,000.00
State Surcharge Fee: $ 4.00
TOTAL FEE: $ 104.00
APPLICANT: Tonka Plumbing OWNER: David&Paula Lindberg
265 Cty Rd 110 North 3440 North Shore Dr
Mound,MN 55364 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPL A TPERMI EE IGNATURE ISSUE BYSIGNATURE
Conies: 1-File(SiQnitures Required),1-Avnlicant, 1-Monthlv Reuorts, 1-Assessin�, 1-Finance Page 1
Sep-it-2002 02:4Tpn From-CITV OF ORONO +9622A64816 ?-018 P.002/006 F-986
CITY OF ORQNO APPLICATIDN FOR PLtTMBING PERMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
('F�.N�'RAL YN�RMA'iTON
1. You may apply for piumbing permi�s by mail or in person az the City offices.
2, Permi[eards will bC sent by rtturn mail aPtEr e ceview is complated. PERMITS ARE NOT VALTD UNTIL
YOU R�CfiIVE A PERMIT'. WORK ST NOT�EGIN UN'P1L THF PFRMIT CA IS POST�D�N
THE O�B SIT�
3, plumbing pern�its rr►aY be xuued ONLY to licensed plumbing com�'actors and m properry owners residing
in the dweUing.
4 qmen aay oew construccion or remodeling is involved,a separate building permit musc be obtained.
5. All work musc be done in aecordanee with the State Code requirerata�s.
6. Alt work must be inspecud and air �ested before it js covered. Call (952) 249-4600. 24-hour nocice
rcquired.
Ins�cti�n Complete all items vn chis application. Compute the pexmit fee. Sign and date the
ccrtificacion. TNCt�MPLETE APPLICATIONS WiLL NOT BE PROCESSED. If�►ou have
quesrians, call (952) 249-4600.
Please check one: Ncw Addition Ytepair Replace
�Residential Commercial
.YOB SYTE: 3 �� (�10� f`. (�O Yl Zip: `� �
Ownec's Name: ` Telephone Number•
MailingAddress: 0 0 �2. . City:_Q�__Y��,�..—.Zip: c.
Contractor's Name• -1� �f- Telephone N ber: �--�-} 7�—�20 C7
Mailing Address: 1.�7 � �: 1A. � Zip:
PY iMB�NG�X_TUR�SC�TEDULE
�'IXTURE BSMT 1ST 2ND OTHER F1JC'fCJRE BSMT 1ST 2I�TD OTHER
TYFE FL FI, TYPE Fl.. FL
Water Closec � � � Floor Drains r
�Ynto o� Scwer E�tctor �
Bachtab � Lau Tra �
Showsr W�r /
Kitchen Ssnk � Wa[er Henttr �
Dis �al Wacer Softener
Dishwasher � Wet Bar r
Sillcocks
� ` Misc ist)
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Sea-11-Z002 D2:41ps Pro�-CITY OF ORONO +65224A4616 T-018 P.003/006 f-9A6
2002 State Ststute ❑ Yes, This Section Applies
1he replacemenc of a Re.�idenraal fixmre or_�n 1'D�anC tbat meets all chree of the following
tequiren1ents:
1) �t �xequire IDaiitieadon co elec�rrical or gas service.
2) Has a total c�of$500.00 or less; exchuti�che cost of thc fixture or appliance:
and
3) Is improveci, installed or replaced by the homeowner or licenced contraccor.
Skip next seCtion; Cost of Pett�tit $ 15.00
State Surcharge $ �SO
Mail Yn Fee $ 1.50
If above does not�pply, follow guidelines below:
1. Con , ct�* is .0125 R'o of job with a Minimmn F��($35.Q9�
�Q�� _ x .0125 $
(contract price) (minimum 535.00)
2, �.�c aree• ** Add tfie Stace Buildin� Code Division a (Minuttum Fee of� .S4)
x .0005 $ �
(conttacc price) (minimum$ .SO)
3. �.and�n� (Un1y mail-in applicatio�) $ _ 1.SO —
4. TOTAL P�RMIT FEE (Add lines 1-3 above) $ _ _
+� CON'I'RAC'f PRYCE er JOB CUST mesns the�tual or escimatod dollar amount cbnrged for the permitud
work inchiding ma�eriais,labor,profit,and ocher fixed cosu. It is the amoun�eo be charged w c!�cuscomer
for�u work done. If any maurial�equipmeni,labor,or inst�llation are fu�shed by che owner,cenanc or
aay othet patty che reasoaable marke�value of such items must be added to che estimaced cose or eontract
price for permit fea purposes• Yn th�ev�nt t�t�e�is a dispu[e on the�tnount of the job cast,ihe Ciry maY
r�si�he suDmission of a sigued copy of the mcwal concrac[•
�* The STA7�SURC�IARGE is.QOOS of tt�c�tract priee under 51,000.000 or S.50-whichewer is greater.
For valna��ons over E1.000.000 call the Deparunent of Inspec[ion Services for the price.
� ���gn�hereby appiies to the City for issuance of a Plumbit�g Pett�lit, agrees to do all
aork in stricc accordanee with tbe ordinances of the Ciry and tbe rcgalations of the State of
Minnesota, and cercifies that all statemenu made ou this application are complete, t�ue an�d
correct.
A licant's Signature� � �•� Dace• � 02
PP
Sea-1�-2002 Oi:aBr� fro�-C�TY OF OR�10 �A522a9d616 T-018 P.006/006 F-9A6
Se�c-13A4 WGfTTS OF SUBJECTS OF D.1't'A
Subd.1. 'l�ps o[data. Tha dp,Ew oE iodirid�ol os a6om�e dua ts smrcd or�be swted SLtil be as sct 60�iA ddt t�.
Subd.2. Zato�wsttaa e�eqnircd tu 6e�veo ladhidml. M io�vidw!adeed ro suPPh P��oteoatideod+�!dtn ceq�smiai�mself�u1!
bo Wo�ud o[: (sl�ha PeR+oae�d breed�d wa ol O�e eeqn�aed dw widda�e copaoaY kaoa a;eeey.PoWieat m6divi�ioo.or�=Ys�em:
(A)wQe�cr M map eelrua or is le�rir Rquiasd ro�upply�he�equ�ead dsa:(c)wY Imeao�o+���f����or�sGaiag m wpp1Y
. priva�er000tidea�t Qao:aad(��a idsoaq oi odKr pctsoas or cati�s au�bOe�d by mee or federil Ifw a�caive d�e dua. 'Ybis�meo�s�
me app�whsn m iadividuat is ask�d eo s�pply iavesdaadre dus�Pues�wiu ro�aeeo 13.82.�ubdhisaa S.n a 4w aafe�eemenc oflfcea •
..a.:.R.r,nlrtsion in tt�individust,�incee�e nx or neooeRv�c 1eAa1d
o �Qf eevenuc maY olKe sha�ro�e�saoiteQ md____ _ - .
�� . .r sd of UfDSC�. '
SnEd.3. Aecrss to data by iod�MdasL Uport�cques�n a�asibte aw6ority�aa iudFidu�i s6�11 be Woimed whe�ber he h�e stibjeci
o!smRd Qxta on�diriduali.and wAetl�e�k is eyssifrcd as pvblie ptiva�e or� =1P����r requose.f�s iodividwl v6o Is 1Aa wqkct
ef�oto4 priraae oc public dao,oq iadividwls sbW ee s�vno mc dan�a�u 14Y clw'te oo bua and:it be dasiea.�be i�dbera�d of tbe caaeeos
sad a�a�ini ol�ac dan. Aher sa'md'i+ridwt haa 6eea s4ow�is perrsm daR ted in[o�d K�s meaa�i.tAt dan�d aot bc d'ee�to bias(bt
six mow�s dueoal�r uoicss s d'upuoe or�cdoa pu�u�nc m d�is�a P�mS�addi4oavl dati ao tLe Wdirldml hss b�a coIIccaed or c�ea0ed.
?hs erspo�n�'ble authori�Y sh�i!�e eapies of tlrs prnnre or puWk d�a u�►�eqrw�by�individual�6�ee o[mc daa.'I'be eespons�le awIIo�q
�yY�ui�e�C teques�i°s pe�s°°m pyr�a umat e�ous of aa�OE.a.ioh�K•and oomp'lu�d�e°opia.
?Ae e�'ble audariry�8 compar irnmed'n�el�.i!�en�le.wid��W'�esc����o dds�ubdivi�.oc�bin Rrs drys of
aex is m� e IlhC c0000tcomplY wi�h d�e cequast
dN d�o[d�e eequase,e�xWdie�Saaudays.3ued�Ys�sod lag�1 bo4dt9�.lt it�e oompl� P� ' .
withio th�e oaoe.he ahaf[so iaR�tm�he adl.idual.sed mR1►Asve ao addi�foe�l tir�days wi�ia whicb oe oompty wth�e Dtqnest,exdudG�Saandays.
Suod�s and kad IwUdsys, '
� Subd.4.�Peoee�r�wluu d��eot sccvrate or oompkte. J1n iadivi0aa!nyy wam.sc die tcac�er or wn�ptc�oess o!pubtic 0�p�vate
da��oneen+ia8 himssu 7o eaercis�d�is�s.aa hedividwt alnll aodh��+��°"���O�'��ma m�a��s ef ine diwpeemeac
The respoasiWe a�►odcY shW'"'i�a 30 days eW�er. (�toceeu me dua(bnod 10 b�inaowuac�or iseomQlea�nd�tssaQt m�odfy past rte�i��s Of'
�o,a„�arc or�an��ain,in�tuaina meip�n�s�a�naa by a�e indi�k oe(b�,a�r u,e maiv+dwt m.r 1�batisvea aw�n eo bs oo�sea. Dso.
�n dtspwoe shatt be dtsetos�d onty i[d�e iodi•idud's�noemeae of d�eac is iae�eded wim We dis�ks�d daa.
1Zoe ea�eeaw►�oon ot d�e tespandOte su�ori�mry be�PP��P��m We�ovtsioss or d�e admiaisalrl.s proceduro ace rtlai�to
caKssrcd eues.
�;� A Y AUVIS4RX
In accotdaaee wich M.S. I3.04,31►bd.2.`Righu af subjeccs of dua".we would lEks to inform you thac your r�quest
foc a permit or license from tbe CuY of Omno or aay of its depsamencs maY caNire you co l�rnish cactAiu Ptiva�t or
cont'►deaNal iaforma[ion.
You are aotitiad diat: � - .
1. The iafarmatioa you ti�taish will be used to de�ermine yout qnaliticuioa for the petmit ot Ifceas�nquated.
2. Yoa t�uy reh�se to supply daat. buc retusa! may re4nire tt:u the Ciry deny t�p�rnoic or li�xnse.
3. 7he informacion msy be shared witb other loeat.stace or federal ageacies to cbe eueac naxssa�Y w Pm�ss
tbe pezmit or liat�se.
4. if yaur cequace� penait or license raqnires Council Accion to apptove� some 't.nformatioa may beco�►e
public. �
S. You havo cettain �i$hts under M:S. 13.04(available npo�te4uest) co review private dua oa youcsetf.
6. Yaur fult narn�e is required eo process chis�pPlicAcioa or pacmlc,
��,����.� � ..
Fitst
Addcess '
, g� ' ?3p P6onR
Cih
I uadecscand my ri�hts stated abova. ,
si�ma�a . �
Sep-11-2002 02:lApA Prae-CITY OF OR� +A6224Ad616 T-018 P.006/006 F-9A6
r�oF oF wox�s� COMP'ENSATION YNSURANCE COV �'RACE �
Nlinnesoca Statute Sadon iT6.182 rcquires every state and lacal l�xas�sig age�cy w witbhold
the issuance or teoea►al of a licensc or permit w operat,e a busi�ess in Minaesota wrtil the
� . $Pp�P�� �ble evideace of compliance aith t1�worbers' compensaaon iasucancc
' coverage requiremeat of Section 176.181, Subd. 2. The infornaation requirod �s: 'rht name of
th�e�insurance company► the policy�awaber, and dates of coverage or the pennit ta self-ins�u�e.
This informatian an71 be colleeced by thc lieensi�ageneY aad Put in their eono�any tile. Ic will
t,e furnish�ed, upon rcqu�st, to the Depazwn�nt of L,abor aad Industry to cluck f,or compliaaece
with Mfnnesota Statut�Sec. 176.I81� Subd. 2.
Tbis information is requined by law, aad licenses an�d permits to operate a busi�ss may not be
issuc8 or reaewed if it is not pmvlded and/or is falsely report�ed. Furthtrmore. if this
information is not pr�vided andJor falsely reported, �t may resalt in a$1,000 penalty asscssed
against thc applicant by t�e Commisaioner of the Depattmeut of i.abor aad Ipdusvy payabk to
� the Special Compansation�nd. .
Provide the lnfdrmation spxiSed abovc in tlie spaces provided, or cestify tl�e precise reason
yowr business is exeluded Prom compliaAce with�iasuc�e coverage requir�ment�or workers'
compensatio�.
�uatica Campeny Name:
( T� thc insuraaac agent) � �
Policy Number or Self-Insuramce Permit Number:
Dates of Coverage:
OR
i am na,t required to havc workers' compensation liability coverage becaase:
(�(j I have no employees covered by the law..
. . ( ) Other(SPxifY) , . �
I HAVE�tF.AD AND UNDERSTAND MY RIGHTS AND OBLTGA7'IONS WITT�RE(�ARDS
TO BUSYI+tF.SS LICBTISES� PERMTTS AND Wd�ERS' COMPENSATION COVERAGE,
AND I CERTIFY THA'� THE INFO1tMATION PYtOVIDED IS TRUE AND CORREC'7'•
tsitu�are> �>
(�Y> l�Phooe 1Vombec)
� �^Y `
�'1 DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE ,� f SCHEDULED c�
PERMIT NO. �L�JL��1 COMPLETED �
ADDRESS_ ��-I L� �`� [�I � ��C�I'�-C� D�-
OWNER CONTR. ��77'1 /� �Gt(!n�
TELEPHONE NO. Cfi ���� - L�� '� �(��-('��,
,
� DESCRIPTION --�- r�I �M b �,1�.� _ ��
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS�
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL �
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS ��
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
`� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PIUMBING FINAL , 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR�MEET YOU:_YES�NO
� COMMENTS: �
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W� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN
�STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
D INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next i pection 24 hours in advance. (952� 249-46��
OwnerlContr�ion 'te•
Inspector. �
White Copy/lnspector's File Canary CopylSlte Notice
�/� DATE TI
c'�=/ J
CITY OF ORONO CALLED IN �
INSPECTION NOTI SCHEDULED
PERMIT NO. `C I COMPLETED
ADDRESS 3 ��(1 f�� r�,re (��2- .
�
OWNER CONTR. ���If,� Pll�b�p�
TELEPHONE NO. �`,J a' ��� � G a-OCi
� DESCRIPTION � � � � � I l
lL 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADIN ILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 OEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBWG RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL ' 36 FOUNDATIOWREMOVAL
� OWNERICONTRACTOR TO MEET YOU:�YES_NO
� COMMENTS: �.-� �� (
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W� WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE
W ❑CORRECT WORK 8.PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� O CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the n�xt inspection 24 hours in advance. (952) 249-46�0
OwnedContr � ite:
Inspector. �
White Copyllnspector's ile Canary CopylSNe Nofice
//
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DATE T1ME
CITY OF ORONO CALLED IN
INSPECTION NOTICE.. SCHEDULED -5-�1 /0:UO j/�
PERMIT N0. ''" �5 COMPLETED �` `'
ADDRESS �y�I� �l/�7/<�7 ��/��IiC.'� ,./,E'
OWNER CONTR. ��l1 �C�` ��U��'f f) •
TELEPHONE NO. C�� ``�/7c� qoZO C�
�
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
W ►v{8!l�lC`i• 23 SEPTIC FINAL 35 HARD COVER REMOVAL
10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� NTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� WORK SATISFACTORY:PROCEED ROJECT COMPLETE
❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑ INSPECTION RE�UIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-46��
OwnedContractor o i •
Inspector.
White Copyllnspector's File Canary CopylSite Notice