HomeMy WebLinkAbout2005-P09180 - vacuum breaker PERMIT
CITY'OF ORONO
275� Kelley Parkway- PO Box 66 Permit Number: P09180
Crystal Bay, Minnesota 55323 Permit Type: Vacuum Breaker
(952)249-4600 Date Issued: 9/14/2005
SITE ADDRESS: 2655 Pheasant Rd Unit#
Excelsior,MN 55331
P��� 21-117-23-23-0005
DESCRIPTION:
Proposed Use: Residential
Permit Class: Plumbing
Permit Type: Vacuum Breaker Permit Sub-type(s): Vacuum Breaker
DETAILS: '
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 15.00 Vatuation: $ 0.00
State Surcharge Fee: $ 0.50
Misc.Fee: $ 1.50
TOTAL FEE: $ 17.00
APPLICANT: Buchman Plumbing Company Inc. OWNER: James&Cheryl Johnson
9215 West 34th Street 2655 Pheasant Rd
P.O.Box 11070 Excelsior,MN 55331
Minneapolis,MN 55411
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 SUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
„ • - `-
FOR CITY USE ONLY
' ,,��� City of Orono
� P.O.Box 66 Date Receivad: Permit#
����� � 2750 Kelley Parkway
�� � �.�, � Crys[al Bay,MN 55323 Approved By: Amount$:
�l�t��_,,� ,}ry�u� (952)249-4600
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CITY OF ORONO-PLUMBING PERMIT
(All Commercial permits must be approved by the Building Official or Inspector)
GENERAL INFORMATION
L You may apply for plumbing perniits by mail or in person at the City oCfices. 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 PERMIT. 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 constructior.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 A 1 )
[]Residenlial ❑ Commercial(Approval Required)
v❑�New ❑Additional ❑Repairs ❑Replace
❑ In Accessory Structure?
*You will need prior approval and may need CUP.(Per Orono City Code,Chapter 78,Article IV)
Job Site/Owner Information:
Site Address: -=� `-1 - , , Y � - ” ' , , �"'=.' �-` `�
Owner:_��=+�-i F' `� -��'�'��; `��c'=�' Mailing Address: �� S 5' f�i-r�.�a->r+-�-� �;- t�� �.
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City: L-,� �: �� � Zip: `�= 3 � I
Home Phone: `1`� =� `-r' �� %%`1 ^: Alternate Phone:
Contractor Information:
; .
Contractor: S"�i�( �t iU�-}r� I Z�t i�,:�,���%� Contact Person: � �C r"F r��i C' N �i�-7
Address: a�� C-%. I�C yL l( � 7 G State Bond#: U'1 G -�
City: `�� f r r��,u-� :-4-,��� ��Zip: ��1 r'�` Expiration Date: 1 Z , � � �c `��-
Phone: �.� �� �`� _� �-i i� i Alternate Phone:
0� Insurance-Current: 7 - � � � � — �� � � � ���
1
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FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER
TYPE FL FL TYPE FL FL
Water 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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❑ Yes,this section applies
The replacement of a 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;excludin¢the cost of the fixture or appliance:and
3. Is improved,installed or replaced by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surchazge $ .50
Mail-In Fee(If Applicable) $ 1.50
Total Permit Fee $ .��
(Permit Fees Continued On Next Page)
2
D. �i� � �k, 1������ L� �,�' g.��..,'
If above does not apply;follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$35.00)
x.0125$
(contract price) (minimum$35.00)
2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50)
x.0005 $
(contract price) (minimum$ .50)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
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 ar 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.
■ ** The STATE SURCHARGE is .0005 of the contract price under$1,000,000 or$.50—whichever is
greater. For valuations over$1,000,000 call the Building Department at(952)249-4600 for the price.
'` � BING�ERMIT A��'` �� �: �' '`�_�,'
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. i
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Applicant's Signatute: �`/ '� �% � Date: � ►� �'�
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BACKFLOW PREVENTER TEST REPORT
BUCHMAN PLUMBING CO., INC.
P.O. Box 11070
Minneapolis,MN 55412
612-588-4707
JOB# SR4374 INSTALL & TEST
SITE ADDRESS: 2655 PHEASANT ROAD ZIP:
55331
OCCUPANT: JAMES JOHNSON TEL.N(� DATE:
_952-471-1142 9/12/OS
DEVICE MAI{�AND MODEL: SIZE: SERIAL#:
FEBCO 825Y 1" 434963
DEVICE LOCATION: MECHAI�TICAL ROOM
DEVICE SERVES WHAT SYSTEM: IRRIGATION
CHECK CHECK PRES.DIF. PRES.DIF.
vALVE#1 vALVE#2 ACRoss#1 WHEN STRAINER
CHECK R�i LIEF
TEST LEAKED(X) LEAKED() NONE(X)
BEFORE CLOSED() CLOSED() psi psi CLND()
REPAIlZS
FINAL TEST CLOSED(X) CLOSED(X) 7.8psi 3.4psi
COMMENTS: REBUILD 2010
YEARI.Y TESTING REQUIRED/REBUILD EVERY 5 YEARS
CERTIFICATION! --I hereby certify the foregoing data to be correct and that the tested
device is functioning within the limits of the standards.
BY: JEFF MARTIN TESTER CERTIFICATION#02030T PHONE #: 612-588-4707