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2004-P07793 - vacuum breaker
� PERMIT CITY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: Po��93 Crystal Bay, Minnesota 55323 Permit Type: VacuumBreaker (952) 249-4600 Date Issued: g�a�2ooa SITE ADDRESS: outlot-Common Area ,� PID: 33-118-23-11-0049 DESCRIPTION: Proposed Use: Uther Permit Class: Plumbing Permit Type: Vacuum Breaker Pernut Sub-type(s): Vacuum Breaker DETAILS: Approved per resolution#: Separate pernuts required: NOTICES/REMARKS: 670 Stone Bay Dr. - 1 RPZ for temp.use-less than 1 year FEE SUMMARY: Pernut Fee: $ 35.00 Valuation: $ 900.00 State Surcharge Fee: $ 0.50 TOTAL FEE: $ 35.50 APPLICANT: Roger Wiley,Inc. �WNER: Dahlstrom Development LLC 47984 Fish Haven Rd. 7745 Polaris Lane Big Stone City, SD 57216 Maple Grove,MN 55311 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. � 1 a APPLI E EE SIGNATU SSUED BY SIGNATURE Copies: 1-File(Sienitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1 JUL.28.2004 1�61PM CITY OF ANOKA COMMUNITY DEU N0.551 P.2 ' >3 I I � �3 I I O��C � C�TY OF OR4N0 APPLICATION FOR PLUMB�NQ P�RMIT Box 66 (2750 Kelley Parkway) Crystal Bay,MN 553Z3 �EIVF;[tAL 1N1�QRMATIOIV 1, You may apply for plumbing permits by rr�'I or ia perso�n at the C1ty oiftces. 2. Permit cards w111 be sent by return mail after a re�iew is completed. 1'FRM['i'S ARE NOT VAi,ID [JIv17L.YOU RECE1rlE A PERM1'f. WtaRK MUST NOT 8�(3IN l�l�Tlyt'fHE PERMI'f CARD_IS ST�D ON THE JOS � 3. F'lumbing permits may be issued ONLY to licensed plumbi�g co�hactors and i�o pro�perty �rs restding in the d�velling. 4. Wh�n any new constr�cEion or rre�model'ing is invoivsd,a separaYe building pernut must 1�obtalned. 5. Al(winrk musi be do�e in accordance wlth the State Code reqNirements. 6. All work must be inspected sad air tested before it is mvered. Cali (952) 249-4600. 24-hour notice required. Ipstntctirnts C�mplete all items oa this app�ication. Compute fhe perm�t Fee. Sign and date the certiticat�oa. rNCQMPLETE APPLICAT"�ONS W[�.L NOT BE PROCL'SSED. If �►ou have questions, call(952) 249-h8Q0. Please check one: ✓New A�dition Repair Replace �`1� i . � �1��Residential Comme.rcial (� �,,i� C„��" P� J�B S . � �� 6 � v s:�.�.� G> Zip: Owner's Name: Teleph�one Number: Mail�ng Addres • City: Zip: � v y,��5 — Contracto�'s Nam�: /Z. � .� Tele hon Number: G�1- Mai�ing Address. ' �ty: ��v Zip: ��'a/� C�'�' �a� �LUMB�NG FI�CTEIRE SCHEDiJLE FQ�TUE�E SSNLT t ST 2ND OTF�R �DZTURE 8SM 1 S 2ND OThIER TYPE FL FL 1YPC T T Fl. � t�I. Water Closet Floor Drains L,$� Sewer C ector Bathtub l.aun Tra Shower Washer Idtchen Sink Water He�fer Dis 1 VVaEer Softener Dishwasher Wet B$�' g�� Misc ist .��=��'�- ��_.�' � �� ,_. � __ _ . Y►� �f a��53�30 � L �,. �� �r� a���7 35� _. _._ � _ __� __u.___.___ .__ __--- ------- - �o� �4����'�'�'� � 2 Pz � �-�� �� JUL.28.2004 1�01PM CITY OF ANOKA COMMUNITY DEV N0.551 P.3 PERMIT FEE CALCULAT�Q��S). �OQ� S�at� � Yes,Th�s Bection Appl�es � � The re�lacement of a Residerrtial ftxtur� or a�plianc� tha# meets a1� t�ree of tl�e follow�ng requirements: 1) oes require modifica�ion to ele�ical or gas service. 2j Has a o co of $500,00 or less; ex u the cAst of the fixture or app[iaace: and 3) Is improved, installed or replaced by tlae homeowner or licenced co�rtractor. Sldp next section; Cost of Permit � l 5.00 Stat� Surchar�e $ _ .50 Mail ln Fee $ 1.50 If above does not appl�,follow guidelines beldw: 1. Con�tt ric � is ,0125 96 oF job with a Min�mum Fee of (.rS35 Q�,O� �'i �� x.O125 $ �contract price) (minimwn$35.00) 2. �tate Surcharge. '�'�Add the State Building Code Dlvision a (Mi�rimum Fee of S .50) x .0003 $ (co�tract price) (miaimum$.50) 3. P�o t,agg,.,an Handl�n� (Ooly rnail-ia applications) $ 1.5� 4. TOTAL PERMI'�`�'EE (Ad�lines 1�3 above) $ * CONTRAL.`T' PRiCE or JOB OOST means the actual or estimated dollar amount charged for the permitted�nmrk irtcludin��natedals, lahor, pro�it,and other flxed costs. ]t�S the amount to be charged tv'the cust�omer fur t,F�e worlr done. lf any material, ecN�ent, labbr, or installattnn are fiumished by ibe owner, tenant or a»y other party the reasonable market value of such ibems must be adde�l to the es4imaied oust or cont�act price for pertnit fee purposQs. In the event tt�t th�ce is a dispute on the amount of tl�e job oost, the Gty may request the submission nF a signed copy of the acfual oontract. �"' The STA1� SURCHARGC 9s .0005 of the contract priee under �1,000,000 or $.50-wltichever is greater. Por valuati�n�over�SI,Odfl,000 caA the Depsrfinent of lnsperfion Servlces for the price. The undersigried hereby apRlies tn the City for issuance of a Plumbictg Pe�rmit, agrees tv do all work in strict acrnrdance with the ordinances of the City and the regulations of th� State of Minnesota, and certifies that all statem��rts ma o this app(ication ar�compl�ete, true and eorrect. AppGcaaYs Signature: D�te: z� U� � ,� ,�, ���„{ti li�l^� ��'e 1' '�%�'I��i���r��'yl��� ,,,,h�k�.�,Y'; . 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