HomeMy WebLinkAbout2012-01032 - water heater CITY OF ORONO * z 0 1 z - 0 1 0 3 2 *
� 2750 KELLEY PARKWAY DATE ISSUED: 10/15/2012
' ORONO,MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1770 SHADYWOOD RD
PIN : 17-117-23-21-0023
LEGAL DESC : SHADY-WOOD
: LOT 018 BLOCK 000
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER HEATER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
APPLIANCE CONNECTIONS STATE SURCHARGE PLBG(<$500) 5.00
1313 DANITA CR. MAIL-IN FEE 2.00
SHAKOPEE,MN 55379
(952)445-4803 TOTAL 22.00
Minnesota State License#:057209PM
OWNER
O'DONOGHUE,DANIEL&SUE
1770 SHADYWOOD RD
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the.State Building Code.This permit may be
revoked at any time for due cause.
�>tiC�C�( LK., � � � �
Applicant Permitee Signature Date Issued By Si ature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
' FOR CITY USE ONLY
O4��o City of Orono
I'.O.Box 66 Date Received: Permit#
27i0 Kcll�y Parkway
��a +�i'x• a.;' Crystal Bay,MN 553'_? ApprovedBy: Amount$:
�t� ��.a > :�o`���� (952)249-4600—Vfain
�rsaod:'" �95?)249-4616 Fax
CITY OF ORONO — PLUMBING PERMIT
(All Coinmcrcial Pcrmits Must be Approved by the State Prior to City Approval)
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GENERAL INFORMATION
1. You may apply for plumbing pennits by mail or in person at the City offices. Applications will be
rcviewed and a pertnit will be issucd within two working days.
2. Permit cards will bc senl by return mail a(ter a review is completed_ PERMiTS ARE NOT
VALID UNTIL YOU RECEfVE A �'ERMIT. W'ORK MUST NOT BEGIN UNTIL THE
PERMIT CARD iS POSTED ON THE JOB SITE.
3. Plumbing peri��its may be issucd ONLY to licc��sed plumbii�g contractors and to property owners
residing in the dwel(ing.
4. When any i�ew construction or remodeling is involved,a separate building permit must be
obtained_
_5. All work must be done in accordancc with Statc Code requirements.
6. All work must be inspected and�ir tested before it is covered. Call (952)249-4600.
(24-48 hour notice required)
TYPE OF PERMiT
(Check All That A 1
�Residential ❑ Cominercial (Approval Required)
❑ New ❑ Additional ❑ Repairs Replace
❑ Tn Accessory Stnicturc?
*You will need prior approval and may need(_['I'. (Per Orono City Code,Chapter 7R,Article iV)
Job Site/Owner Information:
Site Address: �V
Owner: 0 0 Mailing Address: ' �
City: ��1� Zip:
Home Phone: ��� -�-{� 1�__�' � ��� Alternate Phone:
Contractor Information: '
Contractor: Contact Persori:
Appliance c�nnec i ns Inc
Address: 1313 D��,�'l��� Ct' State Bond#: ��i�7 ��/J�'
Shakop��, MIN 5�379 �a
City; n�� '�c ,����_ ExpirationDate:
Phone: Alternate Phone:
❑ [nsurance- Current:
1
PLUMBING FIXTURES BEING INSTALLED
FIXTURE BSMT� t'� 2"D OTHER I=IX"I�URE BSM"I 1'� 2`�' OTHER
TYPF. FL FL TYPF, FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater �
Disposal Water Softener
Dishwasher Wet Bar
� Sillcocks Miscellancous
�� � PERMIT FEE CALCULATION(S) i
BASED OFF - 2002 STATE STATUE �I
❑ Yes,this section applics
The replacement of unlv one Residential tixCure or anpliance that meets all three of the following
requirements:
1. Does not require modification to electrical or gas service.
2. Has a total cost of$500.00 or less, excludin�the cost of the fixture or appliance: and
3. [s improved,installed or replaced by the homeowner or licensed plumbing contractor.
Skip next section,if this applies; Cost of Pcnnit $ 15.00
Statc Surcharge � 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $V�,�7`'`�'
(Permit Fees Cuntinued On Next Page)
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PERMiT FEE CALCULATTON(S)—JOBS OVER $500.00 I
If abovc does not apply; follow guidelines bctow:
1. CONTRACT PRICE * is 1.25%ofi contract p�ice wiC11 a(Minimum Fee of$50.00)
x .0125�
(contract pricc) (minimum$50.00)
2. STATE SURCHARGE
x .0005 $
(conu�act pricc)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
• * CONTRACT PRiCE or JOB COST means the actual or estimated dollar ai�ount 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, equipment, labor or installations are furnished by
the owner, tei�ant or any othcr party, the reasonable market value of such items must be added to the
estimated cost or contract pricc for permit fee pur�oses. Tn 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 inadc on this application are complete, true and
correct.
� ► b � �I �
Applicant's Signature:,� Date:
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