HomeMy WebLinkAbout2016-00169 - plumbing CITY OF ORONO * Z 0 1 6 — P1 0 1 6 9 *
2750 KELLEY PARKWAY DATE ISSUED: 02/16/2016
ORONO, MN 55356-
�^ (952) 249-4600 FAX: (952) 249-4616
ADQitESS : 1205 SHORELINE DR
PIN : 02-117-23-43-0015
LEGAL DESC : REG. LAND SURVEY NO. 0397
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER HEATER
NOTE: REPLACE WATER HEATER
VALUATION OF PLUMBING 0
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.03
APPLIANCE CONNECTIONS, INC. MAIL-IN FEE 2.00
12850 CHESTNUT BLVD
SHAKOPEE,MN 55379- TOTAL 52.03
(952)445-4803 Payment(s)
Minnesota State License#:mech-MB004165 CHECK 7942 52.03
OWNER
JACKLEY ET AL,JAY M
1205 SHORELINE DR
WAYZATA, MN 55391-
AGREEMENT AND SWORIv STATEMENT
The work Yor 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. � /�j, �
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Applicant Permitee Signature Date Issued By Signature Date
�p� City of Orono F4R CITY USEOi�LY ~�'��';:
O P.O. Box 66 Date Received:: j � :�
( 2750 Kelley Parkway � � �� ��•� ���r ��� ��
2� �, Crystal Bay, MN 55323 �����-#,����'� �`{
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CITY OF ORONO — PLUMBING PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
htta:l/www.dli.mn.4ov/CCLD/PDF/pe plumbplanrevapp.pdf
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1. You may apply for plumbing permits by mail or in person at the City offices. Applications will be
reviewed and a permit will be issued within finro 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
POSTED ON THE JOB SITE.
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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)
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�Residential ❑ Commercial (Approval Required)
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❑ New ❑ Additional ❑ Repairs �] Replace
❑ In Accessory Structure?
*You will need arior aqproval and may need CUP. (Per Orono City Code, Chapter 78, Article I�
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Site Address: � �� S�"��%1-^ N� �- .
Owner: �� ��� Mailing Address: � ?.�� ,�'`�����`���-� �
City: Zip:
Home Phone: -t�y �'1�� ��Iternate Phone:
�,���. �-��." �
Contractor: Contact Person: �T�1 I � � ���+��
Appliance Cannections Inc.
Address: �7R�o �►,Psm�,t R�vci State Bond #: ��- � �`� � ��'
Shakopee, MN 55379
City: 952-445-48Q3 Zip: Expiration Date: I 31 1�7
Phone: AI#ernate Phone:
�nsurance — Current: ��� ��� �l� ��^�► �
Page 1
FIXTURE BSMT 1sr 2ND OTHER FIXTURE BSMT 1sT 2ND OTHER
"'fiYPE Floor Floor TYPE Floor Floor
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub � Laundry Tray
Shower Washer
Kitchen Sink Water Heater I
Disposal Water Softener
Dishwasher Wet Bar
ISilicocks I I I I I Miscellaneous I I I I I
1. CONTRACT PRICE " is 1.25% of contract price with a(Minimum Fee of$50.00)
x .0125 $ �' �
(contract price) (minimum $50.OQ)
2. STATE SURCHARGE
� - �' X .000s $ , 0 3
(contract price)
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 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 installations are fumished by the
owner, tenant or any other party, the reasonable maricet 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 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
certfies that all statements made on this application are complete, true and correct.
Applicant's Signature: Date: ,�
Building Official/Inspector: Date:
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