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HomeMy WebLinkAbout2015-00383 - plumbing CITY OF ORONO * 2 0 1 5 - 0 0 3 8 3 2750 KELLEY PARKWAY DATE ISSUED: 04/07/2015 ORONO,MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS 4680 NORTH SHORE DR PIN 07-117-23-32-0050 LEGAL DESC TONKAVIEW GARDENS LOT 000 BLOCK 000 PERMIT TYPE PLUMBING(>$500) PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE FIXTURES-MULTIPLE NOTE: (3)WATER CLOSETS,(4)LAVATORIES,(2)BATHTUBS,(2)SHOWERS,(1)KITCHEN SINK,(1)DISPOSAL,(1)DISHWASHER,(2) SILLCOCKS,(1)FLOOR DRAIN(1)LAUNDRY TRAY AND(1)WATER HEATER VALUATION OF PLUMBING 8500 APPLICANT PLUMBING FIXTURE FEE 106.25 STATE SURCHARGE PLBG(VALUATION) 4.25 LEGEND SERVICES,INC TOTAL 110.50 P O BOX 382 Payment(s) LORETTO,MN 55357- CHECK 7486 110.50 (763)479-5002 76347 OWNER Tonka Lake Properties LLC 3535 CTY RD 44 MINNETRISTA,MN 55364- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. A licant PermiteaSignature Date Issued By Signature Date Apr 06 1502:33p Legend Services Inc 763-479-6003 p.2 FOR CrrY USE ONLY �— a City o 66 g� P_ P.Q.Box 66 ate IVea:ed: Permit © 2750 Kelley Parkway Amount$: Crystal Bay,MN 55323 Approved By: (952)249.4600—Main (952)2494616—Fax zF c� CITY OF ORONO-PLUMBING PERNM Es H O (All Commercial Permits Must be APProved by the State Prior to City Approval) htt :lhvicw.dli.mn. ov/CCLD/PDF! a plumb ianreva df 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 PERMrr. 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 All That Apply) Residential ❑Commercial(Approval Required) Tew ❑Additional ❑Repairs ❑Replace ❑ In Accessory Structure? *You will need prior approval and may need CUP.(Per Orono City Code,Chapter 79,Article IV) Job Site I Owner Information: (��,♦ Site Address: &jq�7 Owner:TV�l-A LAV-L�r�� Mailing Address: of, AN 57S city: Y l"I Zip: 5530Y Home Phone: Alternate Phone: Contractor Information: _I, Contractor: �+ 46 ;WC Contact Person: ' Address: Pd SOX 38r-), State Bond#: t N.�1V Zi City: p:� Expiration Date: Phone: 7�3 �Z a- O)' Alternate Phone: Insurance-Current: -6se , 1 Apr 0615 02:34p Legend Services Inc 763-479-6003 p.3 PLUMBING FIXTURES BEING INSTALLED FIXTURE BSMT 1 T 2 OTHER FIXTURE BSMT FL FL OTHER TYPE FL FL TYPE Water Closet 4 Floor Drains j Lavatory �! 3 Sewer Ejector Bathtub Laundry Tray Shower Washer Kitchen Sink Water Heater Disposal ` Water Softener Dishwasher Wet Bar Siltcocks ^ Miscellaneous PERMIT FEE CALCULATIONS) BASED OFF-2002 STATE STATUE ❑ Yes,this section applies The replacement of only one Residential fixture or appliance that meets all three of the following requirements: 1. Does not require modification to electrical or gas service. 2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance:and 3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor. Skip next section,if this applies; Cost of Permit $ 15.0 State Surcharge $ 5.00 Mail-In Fee(if Applicable) $ 2.00 Total Permit Fee S (Permit Fees Continued On Next Page) 2 Apr 06 15 02:34p Legend Services Inc 763-479-6003 p.4 PERMIT FEE CALCULATION(S)—JQBS OVER$500.00 If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.000) 95o0 x.0125$ r 0� ' (— c�rice) (mini/mum MOO) 2. STATE SURCHARGE 1J 5 QQ x.0005 (contract price) 3. POSTAGE&HANDLING(Only on Mail-ln Applications) S 2.00 Sd 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. PLUMBING PERMIT APPLICATION 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. Applicant's Signature: o� Date: 3 Apr 0615 02:34p Legend Services Inc 763-479-6003 p.5 04/03/2015 12:24:38 PM 507--455-8200 Page 4 ® DATE pedwerfrm '�� CERTIFICATE OF LIABILITY INSURANCE D15 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR ItEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATFVE OR PRODUCER,AND THE CERTIFICATE HOIDEN. IMPORTANT: if the cerMicate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVEDr talbjed to the terms aW eonMtlans of the policy,Certain policies may reWire an endorSerwtt.A statement On this eu"wte does not confer rifts to the Certificate 110ldOr In lieu of such endorsemett s. PRODUCER NAME CLIENT CENTER FEDERATED MUTUAL INSURANCE COMPANYPNaNE� A N NO :5D7-446 4 HOME OFFICE:P.O.BOX 328 I'M Ma1L OWATONNA,MN SSOW INC CE` .CI7 INBMRERS AFFORDING COVERAGE MAIC III INsuRER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 289-342-a INSMRSR B: LEGEND SERVICES INC INWRERC: PO BOX 392 INSMRER D: LORETTO.MN 55357 INSURER E: INI MRER T1 COVERAGES CERTIFICATE NUMBER:14 REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABCVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE;AFFORDED 8Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INGR TYPE OF INSURANCE ML �R POLICY NUMBER POipperryY-ICY EFF POLICY K� l@:AITS EACH OCCURRENCE S110001wD GENERAL LIABILITY DAMAGE TO RENTED $10D,D00 COMMERCIALOENERAL UASILITY CLARTS•AIADE OCCUR NIED ENP CMy am persdnl N N 9869242 0.5/1412014 05114I201S PERSOYAL.6ADVINARY SiA00,COD X BLRLINESS OTINEIYS UASIUTY $2,000,000 GENERAL AGGREGATE OENL AGGREGATEU[J07 APPLIES PER: PRODUCTS-COMPIOP AGO $2,000,000 X POLICY P RCO LOC AUTOMOBILE LIABILITY COMBINED&DiOLE LUd-- 51,000,OOD X ANY AUTO BODILY WJURY{Por person) AL,OWNED SCHEDULED A AUTOS AUTOS: N N 9869243 OV1412014 05/14/2015 BODILY eVJUAY/Por GCC NON•OWIEa ROPE TY AMAOE HIRED AUTW AUTOS UMBRELLA LWB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE ADOREOATE DED I JPET-EwioN WOR G6R6 COMPENSATION X TD�RY MIT' OER� AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $5001000 ANY PROPRIETORMARTNERWECUTNE RIA N 9869244 05!1412014 0511$/2015 A OFfICER1HRABER EKCLUOELYI E.L.DISEASE-EA EMPLOYEE S500,000 IMendewryIn RHI N yes,d, rlbe wder 6.L DISCASE•POLICY UMPT $5001000 DESCRIPTION OFOPERATIONS bel&w DESCRBITION OF OPERATION&r LOCATIONS I VEHICLE&/Abet,ACORD 101,Add)0amd Remarks&cheam,II mon Tom b r"wrsal CERTIFICATE HOLDER CANCELLATION 289342-8 140 CITY OF OROIVO SHOULD ANY OF THE:ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE LEY PKWY THE EXPIRATION DATE THEREOF, NOTICE tARLL BE DELIVERED IN 2750 KELLEY 27SO KE 55356.9387 ACCORDANCE'WITH THE POLICY PROVISIONS. OROAUTHORIZED REPRESENrATfVE ® 10B.20tD ACORD CORPORATION.All rlghts reserved. ACORD 25(2010105) The ACORD dame and logo are registered marks of ACORD Apr 0615 02:33p Legend Services Inc 763-479-6003 p.1 LEGEND SERVICES, INC. P.O BOX 382 201 N Medina St Loretto, Mn 55357 952-472-7360 Mound 763-479-5002 Loretto 763-479-6003-fag TO: Inspections FROM: Mike Randall REGARDING: Please see the following 4 pages for plumbing permit form and insurance info. We will be in tomorrow morning to pick-up and pay for permit. Please let us know if you have any questions. Please let me know if you need any additional info. Thank you. Sincerely, Michael Randall 1 of 5 including cover sheet DATE TIME V CITY OF ORONO .CALLED INSPECTION NOTICE SCHEDULED PERMIT NO. 215 6r)m3 COMPLETED ADDRESS 4iogn tj ti are OWNER TELEPHOKINO. 9(23/79 CONTRACTOR DESCRIPTION W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL UMBING RI ❑ EXCAV/GRADING/FILLING y ❑ FOUNDATION WATERPRO ❑ TREE REMOVAL Z ' �rof ❑ RADON SLAB ECHANICAL RI ElSITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT v ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL v ❑ DEMO-SITE ❑ SE TIC NSTALL ❑ FOUNDATION/REMOVAL OWNERICONTRACTOR TO MEET YOU:_ _NO COMMENTS: CC LU CC CC Q z �I¢slc� r'3 �il�sr moi•,.=r� a W ❑WORK SATISFACTORY.PROCEED ❑ PROJECT COMPLETE CORK CT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY OE CORRECT WORK,CALL FOR REINSPECTION TEMPORARY U BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN r CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR U INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: , Inspector. - White Copy/Inspector's File Canary CopylSite Notice DATE ,!/' TIME / CITY OF ORONO C IN INSPECTION NOTIrEr--. SCHEDULED PERMIT NO. LL��J"WJ�7CO/MrPLETED ADDRESS '--�(,�w') c)'a ; OWNER TELEPHONE NO. LP 17"7I "- CONTRACTOR 3; DESCRIPTION W ❑ FOOTING AL ❑ SEPTIC FINAL ❑ POURED WALL PLUMBIN Q ❑ EXCAV/GRADING/FILLING y ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL J ❑ DEMO-SITE ❑ EPTIC INSTALL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YES—NO COMMENTS: W cc QOka— a—cccc CI RK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE Cr W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call Fin-p-c"lonn"A hours in advance. (952) 249-4600 Owne ti7Inspector. White CopylInspector's File Canary Copy/Site Notice TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO 2 -X3FL5 COMPLETED " ADDRESS Y-'0 8d '24 '�A e-f- ci�'/''ll OWNER TgtEPHONE NO� CONTRACTOR /n ✓ DESCRIPTION �`'✓ W ❑ FOOTING ❑ D 0- FINAL El SEPTIC FINAL Q ❑ POURED WALL 13P MBING RI ❑ EXCAV/GRADING/FILLING C ❑ 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 W ❑AS BUILT-SURVEY ❑SEWER HOOK-UP ❑ FOUNDATION/REMOVAL +t ❑ DEMO-SITE ❑ SEPTIC INSTALL Q OWNERICONTRACTOR TO MEET YOU:_YES_NO nn COMMENTS: /��'� — /S flIOLA nti C cc J0"rfeiskD +t46 -tao to, Q . w i 12s�z<` aiz 3 rile LuW jCc G d�cG• W 0 WORK SATISFACTORY:PROCEED ❑PROJECT COMPLETE RRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY C ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY �j BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p PHOTO TAKEN INSPECTOR WILL RETURN NATION ISSUED ❑STOPORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for"next inspection 24 hours In advance. (952) 249-4600 Ownerr,ontmcWr on site: Inspect.: ' WhIN CopyllnspecWs File Canary Copy/Site Notice