HomeMy WebLinkAbout2004-P07794 - vacuum breaker PERMIT
'CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 Po��94
Crystal Bay, Minnesota 55323 Permit Type: vacuum Breaker
(952) 249-4600 Date Issued: g�ai2ooa
SITE ADDRESS: Outlot-Common Area
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P I D: 3 3-118-23-11-0049
DESCRI PTION:
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Proposed Use: Vther
Pernut Class: Plumbing
Permit Sub-type(s): Vacuum Breaker
Pemut Type: Vacuum Breaker
DETAILS:
Approved per resolution#:
Ceparate permits required:
NOTICES/REMARKS:
2459 Sandstone-
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 900.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Roger Wiley,Inc. OWNER: Dahlstrom Development LLC
47984 Fish Haven Rd. 7745 Polaris Lane
Big Stone City, SD 57216 Maple Grove,MN 55311
THE UNDERSIGNED HEREBY REQUESI'S PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICI'COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNAT SSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Apolicant, 1-Monthlv Reports. 1-Assessine. 1-Finance Page 1
�UL.28.2004 1�81PM CITY OF ANOKA COMMUNITY DEV N0.551 P.2
C1TY OF �ORONO APPLICATION FOR PLUNlBXNQ P�RM1T
Box 66 (2750 Kelley Parkway)
Crystal Bay,MN 553Z�
�.ENERAL lNF�R11'EA'�toN
1. You maY apA1Y fo�plumbing pem�i'ts by mail or an person at the City offtces.
2. Permit cards t�lll be sent by return mail aFter a r�e�ew is com�leteti. AERMI`I'S ARE NOT VALID UN171.YOU
RECEItIE A PERMiT. W'Q12K 11Y1UST NOT 8�(3TN 1.�1t THE PERNLiT CARD�$ PpSTED ON 'I�iE 10S
SLT�,
3. Pltimbing permits may be issued ONLY to licensed plumbing cont�c�ors and io praperty owners restding in the
dwellirtg.
4. When a�y new constn�cEion or remodaling is invo�vsd,a separafe huilding pern�it must be ohtaIned.
5. Alt work musf be docle in accorciance with the State Code reql�irements.
6. Alt work must be inspected and air test�ed before it is covered. CaA (952) 249-4500. 24hour notice required.
It�struct�ons Complete all item.s on this app�ica.tion. Comput� �he permit Fee. Sign and date the
certiFica.t�on. �1�C�MPLETE APPLICATrONS W[�.L NOT BE PROC�S5ED. If �u �tave questions,
call(952) 249-�4fiQ0,
Please checic one: ✓New Addition Repair Replac,�
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Owner's Names�, . Telephone �Vumbec:
Mail�ng Address� City: Zip: —
Canfiracto�'s Name: 2 i � ti� Tele hon Numbef: ��� a- v '��75
Mai�in�Address. ' ity: ��v Zip: �"r�/�
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1ypg FL FL 'IYPC T T FL '
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Watec Closet Ftaor Drains
Lavato Sewer G eclor
Bathtttb laund Tra
Shower Washer
Kltclun Siiilt Water Heafer
Dis 1 Vi�aber So�ten�er
Dishwasher Wet Bar
Si(lrncks Misc t
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JUL.28.2004 1�01PM CITY OF ANOKA COMMUNITY DEV N0.551 P.3
P�RMIT FEE eALC�LAT�4�(S).
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�QQ� SYat�Stafu'� ,�] Yes,Th�s 6ectivn Appl�ea
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The re�lacement of a R�sidential fixtur�„or a,�.plianG� tha# meefs a1i ti�ree of tI�e followxng requirements:
1) oes reqt�ire modifica�ion to electirical �r gas service.
2) Has a o co of $500,00 or less; ex u i the cost of the fxture or app(iance; aad
3} �s improved, installed or replaced by tlae l�omeowner or licenced contractnr.
Slaip next section; Cost of Permit � 15.00
State Su�'charge $ .50
Mail lu Fee $ 1,5Q
If above does not apply, follow guidelines bel�w:
1. Cor�trac riG � fs .0125 46 of job with a Minimum Fee of ($35�,01
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����'��` x.0125 $
�contract price) (miuimum$35.00)
2. Sta.t� Surcharge. '�" Add the State Buildin.g Code DEvision a (Miaimum Fee of� .50)
x .0005 $
(contract price) (minimum�.50)
3. Pa�ta,�e �n Handl�n,� (Onlymail-in appiications) $ i.5U
4. TOTAL PERMI'i`FEE (A►dd lines l�3 abov�} $
'� C�NT�2AC'T PRiCE or JOB CAST means the aetual or estlmated dotlar amount charged for Y1�e permitted work
including�naterlals, lahor, profit,and vther tiaoed costs. It ts the amount to be charged to the customer fnr the work
done. lf any materia{, ec�u�punent, labor, or instaltation are fum3shed by the owner, tenant or any other party the
reasonable ntarket value o( su�ch items must be added to the estimaied cast ar contract price for pertnit f�
purposes. 1n 4he event that thece ie a dispute on the amou�oP tl�e job oost, tl� City may request the submission
n[a stgned copy of the acfual contr�t.
'�� 'Ct�e STA'�'$ SURCHARCxC 9s .0005 of the vontract prtce under �1,000,000 or $.50-whidieveC is gteater.
Por valuation,s over�l,Od0,000 call the Department aF(nspecfion Seruices for the price.
The undersig�ed hereby applies tn the City for issuance of a Plumbing Pez'mit, agrees to do all worlc
�n strict acrnrdance vv�th the ordinanees �f the City and the regulations of the State of Minnesota, and
certifies that all statem��s ma o this app(ication ar�comp��ete, true and correct.
Applicant's Signature: D�te- �-� U 7
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