HomeMy WebLinkAbout2017-00761 - water heater '� � CITY OF ORONO
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2750 KELLEY PARKWAY DATE ISSUED: 07/06/2017
ORONO, MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 2510 SANDSTONE LA
PIN : 33-118-23-11-0021
LEGAL DESC : STONEBAY
: LOT 018 BLOCK 001
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENT[AL
CONSTRUCTION TYPE : WATER HEATER
NOTE: REPLACE WATER HEATER
VALUATION OF PLUMBING 1500
APPLICANT PLUMBING FIXTURE FEE 50.00
CHAMPION PLUMBING LLC STATE SURCHARGE PLBG(VALUATION) 1.00
3670 DODD ROAD- SUITE 100 MAIL-IN FEE 2.00
EAGAN, MN 55123- TOTAL 53.00
�� Payment(s)
Minnesota State License#:plbg-PC000308,mech-MB005365 CHECK 34793 53.00
OWNER
ENGEBRETSON, SALLY HOLMES
2510 SANDSTONE LA
LONG LAKE, MN 55356-
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 only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become nuli 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.
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Applicant Permitee Signature Date Issued B ignature Date
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REC�1�'�.�
�pN� City of Orono FOR�ITY USE ONLY
O P.O. Box 66 O � ��i�,� Date Received -J�-j �7
2750 Kelley Parkway c�U�- � _, _._�����4r f
,� ,, Crysta! Bay, MN 55323 Permit# � -
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CITY OF ORONO — PLUMBING PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
http://www.dli.mn.qov/CCLD/PDF/pe plumbplanrevapp.pdf
GENERAL INFORMATION
1. You may apply for piumbing permits by mail or in person at the City offices. Applications will 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 VALID
UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS
POST�n ON THE JOB SITE.
3. Plumbing permits may be issued ONLY to licensed piumbing contractors and to property owners
residing in the dwelling.
4. When any new construction or remodeling is involved, a separate building permit must be obtained.
5. All work must be done in accordance with State Code requirements.
6. All work must be inspected and air tested before it is covered. Call (952) 249-4600.
(24-48 hour notice required) �
TYPE OF PERMIT(Check AlI That Apply)
�.Residential ❑ Commercial (Approval Required) [Backflow Device: ❑AVB ❑PVB]
❑ New ❑ Additional ❑ Repairs /�Replace
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❑ In Accessory Structure?
*You will need prior approval and may need CUP. (Per Orono City Code, Chapter 78, Article IV)
Job Site / Owner Information:
Site Address: �X5��] '�Ja��e,a,Pi �,.�,,
Owner: ScV.���.N,� {'G�-rn�►. Mailing Address: 5�0 Savn,� or�.� ��
City: fenc� Zip: 5J35(O
Home Phone: �� 37—�D�O� Alternate Phone:
Contractor Information:
Contractor: Cho►MQien P�urv►bino► Contact Person: Q►ebecca �Ghri�}ian
Address: 3G"�p �e�d Rd State Bond #: __�00630$
City: f.aoan Zip: �5ta'� Expiration Date:
Phone: Co51�3(',5-1344 Alternate Phone:
❑ Insurance — Current:
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PLUMBING FIXTURES BEING INSTALLED
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,
FIXTURE BSMT isr 2ND OTHER FIXTURE BSMT 1sr 2No pTHER
TYPE Floor Floor TYPE Floor Floor
Water Closet Floor Drains
�
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Silicocks Miscellaneous
PERMIT FEE CALCULATION
1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.00)
x .0125 $ J�.pO
(contract price) (minimum $50.00)
2. STATE SURCHARGE
x .0005 $ � , ��
(contract price)
3. POSTAGE 8� HANDLING (Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ � �j,�2'�
* CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
permitted work including materials, labor, profit, and other fixed costs. It is the amount to be charged to
the customer for the work done. If any materiaL eq�ii�ment, lahpr or insta!!ations ars furnished �y ,h�
owner, tenant or any other party, the reasonable market value of such items must be added to the
estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the
amount of the job cost, the City may request the submission of a signed copy of the actual contract.
PLUMBING PERMIT APPLICATION AGREEMENT
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
certifies that all statements made on this application are complete, true and correct.
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Applicant's Signature: Date:
Building Official/ Inspector: Date:
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