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CITY OF ORONO APPLICATION FOR PLUMBING P$RMIT �: <br /> �, `/.� E;/�, <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. r <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 /> *************************************************************************** <br /> 3Co C�'� �� -t`c�� x'• �c�� <br /> JOB SITE ADDRESS: � 'W - <br /> Occupancy Type: �_� Resi entia Commercial <br /> OWNER'S NAME: �l�-�-�;':�-° ti.� ���'� Phone No. : <br /> Mailing Address: City: <br /> � 7 � <br /> CONTRACTOR'S NAME: /�-c?�d� CC-yyL .1-� _ Bu s. No. • '%��� � - � � <br /> Mailing Address: E -- ( -� ��-e City: ��c��-r�-{� Zip: .5=5;3�', <br /> Master Plumber' s State License No. z 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 /> ------------- ---- ----�----- ----r----- ------ ------------- ---- ----�---- --------- -- <br /> � Water Closet � / Sewer Ejector <br /> ------------- <br /> ---- -------- ---- --- <br /> Lavatory Laundry Tray <br /> ------------- -1- --�---- -------- ------ ------------- -�- ---�----- --------- ----- <br /> Bathtub Washer <br /> ------------- -----�--1---- -------- ------ ------------- ---- ---^---- --------- ----- <br /> Shower i Water Fieater / !� <br /> ------------- ---- --•----- -------- ------ ------------- -•�- ---�----- --------- ----- <br /> Ritchen Sink 'I / Water Softner <br /> -------------1----- --•----- -------- ------ ------------- ---- --------- --------- ----- <br /> Disposal � Wet Bar <br /> -------------1----- --!--- ------ ------ ------------- ---- ---.---- --------- ----- <br /> Dishwasher f --_-_- Sump Pump ' <br /> -------------�----- ---- --- --------- ------------- ---- ------- ---------- ----- , <br /> Sillcocks • Misc. (List) <br /> ------------- ----- --�•--- --------- ------ ------------- ---- ---- --- ---------- ----- <br /> Floor Drains / � <br /> --------- ------ ------------- - <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) S <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 /> � ' C� /�'— �C> � 't I <br /> Signature of Applicant: ���� ' -�y'� Date: / ' <br /> .. - r <br />