HomeMy WebLinkAbout2003-P06959 - plumbing PERMIT
CITY OF ORONO
2750 Kzlley Parkway - PO Box 66 Permit Number: Po69s9
Crystal L ay, Minnesota 55323 Permit Type: Fixtures
(952) 249-4600 Date Issued: ioi29i2oo3
SITE ADDRESS: 2735 Shadywood Rd
Excelsior,MN55331
P I D: 21-117-23-24-0005
DESCRIPTION:
Proposed Use: Kesicientiai
Pernut Class: Plumbing
Pernut Type: Fixtures Pernut Sub-type(s): Multiple Fixtures
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 56.25 Valuation• $ 4,500.00
State Surcharge Fee: $ 2.25
TOTAL FEE: $ 58.50
APPLICANT: Robillard Plumbing(See Comments) OWNER: Richard&Sue Gay
10720 Dunkirk Lane N 2735 Shadywood Rd
Maple Grove,MN 55369 Excelsior MN 55331
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.
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AP LICANT PERMI SIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Anplicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
CITY OF ORONO APPLICATION FOR PLUMBING PERMIT
Box 66 (2750 Kelley Parkway)
Crystai Bay, MN 55323
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City offices.
2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT VALID UNTIL YOU
RECENE A PERMIT. WORK MUST NOT BEGW UNTIL THE PERMIT CARD IS POSTED ON THE JOB
SITE.
3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property owners residing in the
dwelling.
4. When any new construction or remode(ing is involved,a separate building permit must be obtained.
5. All work must be done in accordance with the State Code requirements.
6. All work must be inspected and air tested before it is covered. Call (952) 249-4600. 24-hour notice required.
Instructions Complete all items on this application. Compute the permit fee. Sign and date the
certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions,
call (952) 249-4600.
Please check one: New Addition Repair X Replace
�Residential Commercial
JOB SITE: 5 S� i�{' �(� Zip: 55�� (
Owner's Name: � � ' Telephone Number:
Mailing Address: 2�3 S City: �Up�(� Zip: , " 3 �;��c�3���
Contractor's Name: ` Telephone Number:�7(���,���2U -��14
Mailin Address: �
g fi�' � City:jQ��—ly�j�„Zip: 553�q
PLUMBING FIXTURE SCHEDULE
FIXTURE BSMT IST 2ND OTHER FIXTURE BSM 1S 2ND OTHER
TYPE FL FL TYPE T T FL
FL
Water Closet + Floor Drains
Lavato Sewer E'ector
Bathtub � Laund Tra
Shower � Washer
Kitchen Sink Water Heater
Dis sal Water Softener
Dishwasher Wet Bar
Sillcocks Misc list
�PERMIT FEE CALCULATION(S)
2002 State Statute ❑ Yes, This Section Applies
The replacement of a Residential fixture or appliance 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) Is improved, installed or replaced by the homeowner or licenced contractor.
Skip next section; Cost of Permit $ 15.00
State Surcharge $ .50
Mai( In Fee $ 1.50
If above does not apply, follow guidelines below:
1. Contract Price* is .0125 � of job with a Minimam Fee of ($35.00�
�45CY�. pO X .o�aS � �(F �2�
(contract price) (minimum$35.00)
2. State Surchar�e. **Add the State Building Code Division a (Minimum Fee of$ .50)
'�SC�. �� X .0005 $ L� 25
(contract price) (minimum$.50)
3. Postage and Handling (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 5�,�
* 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, equipment, labor, or installation are 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. [n 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 $.50-whichever is greater.
For valuations over$1,000,000 call the Department of Inspection Services for the price.
The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work
in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and
certifies that all statements made on this application are complete, true and correct.
Applicant's Signature: � Date: /O � Z g- 0 3
� � „ ' .---_ . -----_--_ .. ---------
�tate of �in�te�ata '
f�C�ttnegot� �t��rtment of �ealt�j
p�LiG if�RT. e0B 6a975
121 �AST SSV$�1'!! PI�. 8'1'. p�, � 55164-0975
Maatrr Plus�r Lic�ee
LIC�B 11D N387'.�!! BF � � HO 0Ar72�T
.
Q� J� L. i�illard
107Z0 Dunkirk I.�le �tiorth
Maple �rove, 2�t 55369 �
EFFECTIYE MTE EXMRATlON pATE
el/01/Z003 12/31/2003
1
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( MII�IESOTA DEPARTMEMT OF HEALTH - 80NDIN6 MD II�SUtANCE CERTIFICAIE ,� I
' � This is to certify that Joseph L. Robillard. Master Pl�nber License �� �
Na, Pp1003873, represe�ting Robillard Plumbing b�Maintenance has filed a �i �
ub
;�1� S25.OU0 bond with the Secretary of State on August 22. 2003 and provided �� ;
::I� evidence of Fublic Liability Insurance, including Products Liability Insurance �1 `
; �� of at ieast 550.000 pe� pe�son and 5100.000 per occurrence and Property Damage ;; �
��I Insurance of at least 510,000 for the year 2003 in accardance with the ;� :
;�� provisions of Minnesota Statutes, Seetion 326.40. ': �
_
'�� BaVD N0. 40880515 POLICY N0. 40880515 `' '
i Western Surety Company Western Surety Co�any 3� �
!! Sioux Falls, Saith Dakota Lynn D. Nelson, Mi�nesota Agent �' �
! Rosevi 11 e. Mi rmesota '? �
i�� �! `
I�At JOSEPH L ROBILLARD !� `
;�j RQBILLARD PLlA4BING b MAINTENANCE ��'_ , �. ,�� '� '
( � �PLE GROHE�MN N55369� �`�"`'""'
, f; ;
� � Patricia A. Bloangren. Director �: �
� Division of Environ�nental Health '' '
:�i '� �
;, :
;� Dianne Mandernach. Coamissione� ;! '
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TOTI� P.01