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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: 4695 North Shore Drive <br /> Occupancy Type: X Residential Commercial <br /> OWNER'S NAME: _Stephen Ward Phone No. : 472-1879 <br /> Mailing Address: _4695 North Shore Dr . City: Mound , 55364 <br /> CONTRACTOR'S NAME: Owner 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 type on each floor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT IST FLOOR 2ND FLOOR OTHER <br /> ------------- ---- ----a----- ----r----- ------ ------------- ---- --- ---- --------- ----- <br /> Water Closet X X Sewer Ejector <br /> ----------------------- ---- ------ -------------- ---- --- ----- ---------------- <br /> Lavatory <br /> ---- --------- ----- <br /> Lavatory X X Laundry Tray <br /> Bathtub X Washer <br /> ------------- ----- ------- --------------- ------------------- ----------------------- <br /> Shower <br /> --- --------- ----- <br /> Shower X X Water Heater <br /> Kitchen Sink Water Softner <br /> ------------- ---- ------- ---------------- ------------------- ------- --------- ---- <br /> Disposal �- Wet Bar <br /> ------------- ---- ------- ------- ------ ---------------------------- --------- ----- <br /> Dishwasher Sump Pump X <br /> Sillcocks Misc. (List) <br /> Floor Drains <br /> ---I----- -------- ---------I-------------------- ---- -------- ---------- <br /> 1. <br /> -------1. Fixture Fee The minimum perm*t fee is $30.00 $ ', l/© <br /> Compute number of fixtures x $8/fixture <br /> x $5/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) $64,Sb <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: �� ��i/l/ Date: 1 �� <br />