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+ 4+ CITY OF ORONO APPI,ICATION FOR PLUMBING PERMIT <br /> � • Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> General Instrnctions <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 invol ved, 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 honr notice reqnired. <br /> *****�********************************************************************* <br /> JOB SITE ADDRESS: <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: e ' ; f e Phone No. : �� 7 3 � h' � �3� <br /> � , n <br /> Mailing Address: / �y rb S�� City: ��o,.,.�, <br /> CONTRACTOR'S NAME: Bus. No. : <br /> Mailing Address: City: Zip: <br /> Master Plumber' s State License No. : City Cert. No. : <br /> *************************************************************************** <br />• ^ PLUMBING FIXTURE SCHEDULE <br /> - (Show number of fixtures of each ty�e on each floor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> � ------------- ^---�----- --=-r----- ------ ------------- ---- ----^---- --------- <br /> __�—___ -- <br /> v:ater Closet ( � i% _--__ Sewer Ejector <br /> ----------- �---- ------ - - --- ----------- --- --•---- ---------+------ <br /> --- - - - - - - - <br /> ' �. I <br /> Lavatory � ' y., , Laundr Tra �-_ , <br /> --------------*---- ---—---- --------1------ ------y----y- --- ---�----- ---------L----- <br /> -; - <br /> I ' <br /> Bathtub i � � -__-_ Washer I <br /> --------------�-------------i------- - ------------- ---- ---^---- ---------�----- <br /> _ Shower � I � � Water Heater j <br /> � --------------�-----=--•----- ------- ----- ------------- ---- ---•----- ---------� ----- <br /> � <br /> � I <br />.-„ � ,-: Ritchen Sink ', � � Water Softner <br /> -------------------=--�-----�--------1------ -------------1---- ---�----- ---------=----- <br /> Disposal-----1---- � ---- ------�----- Wet_Bar----- -- ---•---- -------- I ---- <br /> i - - - - - - - -�- <br /> Dishwasher ` __--�, �_--___ Sump Pump <br /> -------------1- L------- ------ ---------- --- ------- ---------- ----- <br /> Sillcocks ( Misc. (List) <br /> ------------ ----�----•-- --------- ----- ------------ ---- ------- ---------- ----- <br /> Floor Drains �/ <br /> _____________ _____1________ _________ ______ _____________ ____ ________ __________ _____ <br /> *************************************************************************** <br /> 1, Fixture Fee The minimum permit fee is $30.00 $ <br /> Compute number of fixtures x $5/fixture <br /> x $3/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage & Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �7b� � � U <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 /> ,, <br /> Signature of Applicant: � Date: �. -J�' `� �] � <br /> oe; _ <br />