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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 /> E' General Instructions <br /> f; <br /> 1. You may apply for plumbing permits by mail or in person at the City offices. <br /> �y' 2. Mailed in a <br /> �; pplications 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 yon receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Plumbinq 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 muet 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 /> ***********,t***************************************** *****************,t*** <br /> JOB SITE ADDRESS: /�+S � � �� <br /> Occupancy Type: � Res�dr�ntla] � <br /> --T--�— -----..�.iiuiicL c,l a 1 <br /> OWNER'S NAME: <br /> Mailing Address: Phone No. : <br /> City: <br /> CONTRACTOR'S NAME: � � � � �� ° <br /> Mailing Address: Bus. No. ; 3 �'=�j�"�,� <br /> Master Plumber's State Licen e No. . �� S City: , j�� G� s <br /> ' �a �/�- CaM City Cert. No r; Zip: S" �(�,(� <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 /> . <br /> . ------ ---- ----a----- <br /> ���� ���T����� �_���� ��'���������� <br /> Water Closet r3 "-- ----�---- - <br /> -------- ----- <br /> ------------- <br /> Sewer Ejector <br /> ---- --�— <br /> ---- ---- ------ <br /> ------------- <br /> Lavatory ---- ---•----- <br /> � --------- ----- <br /> - Laundry Tray <br /> -- -------- <br /> -------- ------ <br /> / ------------- <br /> Bathtub '--- ---•----- <br /> --------- ----- <br /> ' Washer <br /> ------------- -----�---- <br /> ---- --------- ------ <br /> � I ------------- <br /> Shower ---- --------- --------- <br /> ----- <br /> � Water Heater <br /> ' ------------- -----�--�----- <br /> --------- ------ ------------- <br /> Ritchen Sink "" '--•----- ------___ <br /> ----- <br /> � Water Softner <br /> -------------�+- <br /> l ----�--•----- <br /> � -------- ------ <br /> ------------- <br /> Disposal ---- ---�----- <br /> --------- ----- <br /> - Wet Bar <br /> ! ------------- <br /> ----- ------ <br /> r ------- ------ -------- <br /> ' Dishwasher � ----' "'- ---•---- <br /> --------- ----- <br /> Sump Pump <br /> - ----•--- ---------- <br /> ------ ------------- <br /> Sillcocks � ---- ------- ---------- <br /> ----- <br /> � Misc. (List) <br /> � --- ---•--- --------- <br /> ` ------ ------------- <br /> t Floor Drains '--' '------ ---------_ <br /> --- ---�---- --------- <br /> ------ ------------- <br /> **************************�************************************************ <br /> l. 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 <br /> $ .50 <br /> 3. Postage & Handlinq (Only mail-in applications) $ <br /> 1.50 <br /> 4• TOTAL PERMIT FEE (add lines 1-3 above) <br /> *******************************************************************,a******* <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 Ar.nl;�a.,� . � ��. . D _ �`-` . ,� . / _ <_ _ <br />