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CITY OF ORONO * z � 1 7 - � 1 3 7 1 *
2750 KELLEY PARKWAY DATE ISSUED: 10/20/2017
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 600 PINEHURST CT
PIN : 06-117-23-34-0007
LEGAL DESC : LAKEVIEW OF ORONO
: LOT 19 BLOCK 1
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER SOFTENER
NOTE: 1 WATER SOFTENER
VALUATION OF PLUMBING 500
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.25
WATER DOCTORS TOTAL 50.25
8201 CENTRALAVENUE Payment(s)
SPRING LAKE PARK,MN 55432- CREDIT CARD 8557 50.25
(763)535-1800
Minnesota State License#: mech-WC645002
OWNER
Gonyea Homes
1000 BOONE AVE N
#400
GOLDEN VALLEY,MN 55427-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to •
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for onty the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
��r/� / /
Applicant Permitee Signature Date Issued By Signature Date
. • , r �
��,,ON City of�rono �o�t G�t�r usE otv��
� P.O.Box� Date Received:
2750 Kelley Parkway
-� �. Crystal BaY,MiV 5532� Permit#
��"', c,` 952 249-4600-Main
'�ti"�rsHi�a`` (952)249-4616-Fax APP!'OVed 8y:
� Amount$.
CITY OF ORCSNO-PLUMBING PERMIT
I(All Commercial Permits Must be Approved by the$tate Prior to City Approval)
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GENERAL !N URMATiON
1. You may appty for plumbing permits by ma�il or in person at fhe City offices. Appiications wi(i be
reviewed and a permit wiil be issued within two working days.
2. Permit cards wiit be sent by return mail after a review is compfeted. P�RMITS ARE N07 VAUD
UNTlL YOU RECEIVE A PERM(T. WQRK MUST Nt)T BEGIN UNTiL.THE pERMtT CARD!S
POSTEQ QN THE JOB SiTE.
3. Plumbing perrnits may be issued ONLY to ticensed p{umbing contractors and to property owners
residing in the dwetling.
4. When any new construction or remodeling is involved, a separate building permit must be ob#ained.
S. All work must be done in accordance with State Code requirements.
6. All work must be inspected and air tested before it is cavered. Call(952)249-4600.
(24-48 hour notice required}
TYPE OF PERMtT(CheeEc AlI That APA�Y)
'"�[Residentia! ❑ Commerciat(Approval Requfred} (Bflckflow I)evice:Q AVB ❑PVB]
1 '
❑ New ❑Additionat ❑ Repairs � Replace
❑ �n Accessory Structure?
"'You will need prior aoqrova(and may need CUP. (Per Orono City Code, Ch�pter 78,Article!1�
Job Site/Ownec tnformation:
Site Address: � � �.,� ' ��U�.C�
C}wner:_ �'��=Q�- Mailing Address: i
City:-�.�,.���.— Zip: __���' J�c,��
Home Phone; Alternate Phone:
Con#ra�tor Infarmation:
Contractor:�������� Contact Persan: �..J� ���,�.Q ���Y,.�:'.�''t
� �
Address: ���� ��Y1��� ��.r_.�State Bond#: ��1�� t�
� �
City: �--��� � t�Y�- Zip: ����2- Expiration Date: � ��
Phone: � ' �� Atternate Phone:
�1J Insurance-Current; �.�
Paqe 1
.... .. . I £ �'�.i
City of Orono _ :'� ��R�t't'�.U���i��:�
� . � �����.-
�'�O P.o. eox ss Date:Recei�tetl. =i , s
t 2750 KeBey Parkway z
.+ Crystal Bay,MN 55323 ���4�� ='`
ti�^��� � ��u� � (952)249-4600—Main Appft�vetl By' `..
�ESHo (952)249-4616—Fax
Aimoctti#$:, : , _ . ,` ,
CITY OF ORONO-PLUMBING PERMIT
(RII Commercial Permits Must be Approved by tthe State Prior to City Approvala
htta:llwww.dli,mn.c�ov/CGLQIPDF/� plumbplanreva�p.e�df
C��Ef�L:IN URMP�TIL�N
� --- _
1. You may apply for plumbing permits by maii or in person at the City offices. Applications wiil be
reviewed and a permit will be issued within two working days.
2. Permit cards will be sent by return mail after a review is completed. PERMiTS ARE NOT VAIID
UNTIL YOU RECENE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS
POSTED ON THE JOB S�ITE.
3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property owners
residing in the dwelling.
4. When any new construction or remodeling is involved, a separate building permitmust be obtained.
5. All work must be done in accordance with State Code requirements.
6. Alt work must be inspected and air tested before it is covered. Call (952)249-4600.
{2448 hour natice required)
: .T''�(PE bF PEf�M1T(�heck Alf That App���,.
�Residential ❑ Commercial {Approval Requiredj [Backtlow Device:�AVB ❑PVB]
❑ New ❑Additional ❑ Repairs ❑ Replace
❑ In Accesss+ory Structure?
�`You wil! need prior aaaroval and may need CUP. (Per Orono City Code, Chapter 78, Article IV}
:fob Site 1 C7wner Inforrn�ticari:
Site Address:
Owner: Mailing Address:
City: Zip:
Home Phone; Alternate Phone:
Cc�n#r��tOr;t�►f�rt'tt7ati�n;' �
Con#ractor:���i �„JGt..��j Contact Person: ��U�- ��-�
Address: ���� ����� ,���� State Bond#: ���y��
4 �
City: �-��� �� � Zip: ����J�- Expiration Date: � �
Phane: ' v"" Alternate Phone:
`�] Insurance-Gurrent:
Pa�oe 1
� � � i i!
FIXTURE BSMT �ST 2ND 07HER �IXTURE BSMT �ST 2ND OTHER
TYPE Floor Floor TYPE Floof Floor
Water Claset Fioor Drains
Lavatory Sewer Ejector
Ba#htub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Silicocks Miscellaneous
�. ,
� �
�
1. CONTRACT PRICE *is 125°lo af contract price with a(Minimum Fee of$50.00)
x.0125 $ ��
(contract price) (minimum$50.00)
2. STATE SURCHARGE
x .0005 $ g 2..�
(contract price)
3. POSTAGE& HANDLiNG (Only on Mail-In Applicatior�s) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ,:__�� ���
* CONTRACT PRiCE or JOB COST means the actual or estimated dollar amaunt charged for the
permitted work including materials, labar, protit, and other fixed costs. It is the amount to be cMarged to
the customer for the wark done. tf any material, equipment, labor or installations are fumished by the
owner, tenant or any othe� party, the reasonable market value of such items must be add�! to the
estimated cost or contrac# price for permit fee purposes. In the event that there is a dispute on th�
amount of the job cost, the City may r�uest the submission af a signed copy af the actu�l contract.
The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in
strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and
certi�ies that all statements made on this application are compie#e, true a�d correct.
ApplicanYs Signature: Date:
Building 4fficieU Inspector: Date:
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