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CITY OF ORONO APPLICATION FOR PLUMBING PERMIT <br /> Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> General Instructions <br /> 1. You may apply for plumbing permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fees shown below. <br /> Permit cards will be sent by return mail the same day the application is received. <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Plumbing permits may be issued to licensed contractors only. <br /> 6. When any new construction or remodeling is involved, a separate building permit must <br /> be obtained. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 hour notice required. <br /> JOB SITE ADDRESS: TDA.✓ <br /> Occupancy Type: X Residential Commercial <br /> OWNER'S NAME: o f Al4-Z-c. Phone No. : <br /> Mailing Address: �/ y S r,,,r�i- 7-0z,_,,,41 rlp City: b60 ni'C Z-A k, <br /> CONTRACTOR'S NAME: Bus. No. : 41-3-Y,16-3 <br /> Mailing Address: City: Zip: <br /> Master Plumber's State License No. : 7c City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDULE <br /> (Show number of fixtures of each type on each floor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> -------------- ---------4----- ---T------------- ------------------- --------- ---------------- <br /> Water <br /> ---- ------ ------------- ---- -------- -------- ---- <br /> Water Closet Sewer Ejector <br /> ------------- ---- -------- ----•---- ------ ------------- ---- ---•----- --------- ----- <br /> Lavatory Laundry Tray <br /> ------ ---- --—---- ----------------- ---------------------------- ---------------- <br /> Bathtub <br /> --- ------ ------------- ---- ---•-- ------ ----- <br /> Bathtub Washer <br /> ----------- ------------------- ------------------------- <br /> Shower <br /> -- --------- ----- <br /> Shower Water Heater <br /> ------------ ------------------- ------------------------- <br /> Kitchen <br /> ---- --------- ----- <br /> Kitchen Sink Water Softner <br /> ---- ---- --- ------ ----- <br /> Disposal Wet Bar <br /> ------------- ---- ---•--------------------- <br /> Dishwasher <br /> --- --------- ----- <br /> Dishwasher Sump Pump <br /> ------------ ------------------ ------- ---------- ----- <br /> Sillcocks Misc. (List) <br /> ------------- ----- <br /> Floor Drains A/ iV a S'�✓i T� c'✓D' 2 <br /> ------------- ----- -------- --------- ------ --70�(/6rG✓ i+rL----------------- _ <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ <br /> Compute number of fixtures x $8/fixture <br /> x $5/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage i Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, <br /> agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this <br /> application are complete, true and correct. <br /> Signature of Applicant: Date: 6 -"'-1 �� <br />