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Home My WebLink About2013-00999 - replace water heater s ^ CITY OF ORONO * 2 0 1 3 - 0 0 9 9 9 * 2750 KELLEY PARKWAY DATE ISSUED: 09/26/2013 ORONO, MN 55356- (952)249-4600 FAX: (952) 249-4616 ADDRESS : 2106 SHADYWOOD RD PIN ; 17-117-23-42-0017 LEGAL DESC : WILEYS PARK LAKE MTKA : LOT 000 BLOCK 001 PERMIT TYPE : PLUMBING(<$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : FIXTURE NOTE: REPLACE WATER HEATER APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 APPLIANCE CONNECTIONS STATE SURCHARGE PLBG(<$500) 5.00 12850 CHESTNUT BLVD SHAKOPEE,MN 55379 MAIL-IN FEE 2.00 (952)445-4803 TOTAL 22.00 Minnesota State License#: 057209PM OWNER JR., WILLIAM SIME 653 SHADYWOOD RD ,FL 34145- - - -- _ AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according.to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. . 4i '�y, �-3 9 .21�✓ ,(j Applicant ermitee S' ure Date Issu By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. r CI USE ONLY �4p� CityofOrono �EC ED ��/y 3-0 �� P.O.Box 66 E�V Date Receiv l Permit#OCf/� � �ap„ „ �� 2750 Kelley P.�rkway � � �fi•'�`�_- �� Crystal Bay,MN 55323 ��P � Approved By: _ Amount$:_ � � "�o��o, (952)249-4600 � `- 5 ZO�3 _� CITY OF UI201�I��I:BINCF 1'ER1�3IT (All Commercial permits must be app:oved by the Building Official or ir.spector) GENERAL INFORMATION 1. You may apply for plumbing permits by mai!or in person at the City offices. Applications will be reviewed and a pennit will be issued within two working days. 2. Permit cards will be sent by return cnail after a review is completed. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB S1TE. 3. Plumbing permits may be issued ONLY to ticensed plumbing contractors and to property owners residing in the dweliing. 4. When any new construction or remodeling is involved,a sepazate 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 All That Apply} �Residential ❑Commercial(Approval Required) � ❑New ❑Additional ❑Repairs ❑Replace ❑ In Accessory Structure? *You will need arior aaaroval and may need C UP.(Per Orono City Code,Chapter 78,Article IV) Job Site/Owner Information: Site Address: t� f �" L Owner:��k�_�� " � 1Vlailing Address: City: Zip: Home Phone: � � - L Ci(,� Alternate Phone: Contractor Information: � , � �Contractor: Contact Person: . .� App Inc. Address: 12850 Chestnut Blvd�. State Bond#: ��Y , City: 952-445-48��. Expiration Date: Phone: Alternate Phone: ❑ Insurance—Current: � , - --- P UI�1��ING FIXTURES BP;1NG INSTALLED FIXTURE BSMT ls 2 ° OTHER FIXTUI2E � BSMT ls 2 OTHER TYPE FL FL TYPE FL FL Water Closet Floor Drains Lavatory Sewer Ejector Bathtub Laundry Tray Shower Washe* ; i i Kitchen Sink Water Heater Disposal Water Softener Dishwasher We�Bar Sillcocks Miscellaneous I � _ � I�ERMIT FEE CALCULATION(S) j BASED OFF -2002 STATE STATUE_ � Yes,this section applies The replacement of only one Residentiai fixture or appliance that meets all three of the following requirements: 1. Uoes not require modificaiion to electrical or gas service. 2. Has a total cost o:$500.00 or less: exclu�ii�the�ost of the fixture or appliance: and 3. Is improved,installed or replaced by the homeo�nex nr licensed plumbing contractor. Skip next section,if this applies; �ost of Permit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ � ��v (Permit Fees Continued On Next Page} 2 . . If above does not apply;follow guidelines below: 1. CQNTRACT PRICE * is 1.25%of contract price with a(Minimu�Fee of$50.00) , x.0125$ (contract price} (minimum$50.00) , i 2. STATE SURCHARGE •'�Add the State Bldg Code Div.Surcharge(Minimum Fee of 55.00) • x.0005 $ (contract price) ' (minimum S 5.00) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Abave) S V ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the pemvtted work including materials,labor,profit,and other fixed costs. It is the amount to be chazged to the customer for the work done. If any material,equipment, labor or installations aze furnished by the 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. ■ **The STATE SURCHARGE is.0005 of the contract price under$1,000,000 or$5.00—whichever is greater. For valuations over$1,000,000 call the Buiiding Department at(952)249-4600 for the price. 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 aze complete, true and correct. ' , � Applicant's Signature: , o Date: � v " � �r � "��,.�Y_ _. 4i/ . , � � •. � � '� � 1 ! ' , � _ 3 �