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Home My WebLink About1986-8758 - plumbing i GENERAL PERMIT � ��P�� N� s 7 5 s �;IT"Y OF ORONO � ` l� -a - P.O.BOX 66 Date CRYSTAL BAY,MINNESOTA 55323 . (612)473-7357 - Owner �I.c,) i �'1 __1(�1�� QS Address I'�l��=h or.� 1 ��f1 Z. �'Ir Contractor � Address ��Y f"1" 7"-e/ .DY: Clt}+J 10EC1SC N0. /`'' Clty .�/ n r%Y'� REMARKS AND SPECIAL CONDTTIONS PERMIT TYPE AND FEE:� � NEW O ADDTI'ION ❑ REPAIR ❑ REMODEL Inside Plumbing(#fixtures�) Fee $ �� Water Well Fee $ Water Meter(Size ) Fee $ MechanicaZ Equipment Fee. � Meter# Fireplace/Wood Stove Fee $ Remote# Moving/Iafting Buildings Fee $ Municipal Water Connection Fee $ Land Alteration(Fxcavation, ❑ Copper O Grading,Fillint8,etc.) Fee $ Design Review Fee $ Municipal Sewer Connection Fee $ Fire Fee $ 0 PVC ❑ Cast ❑ Sprinkler System(Fire) ,� Fee S MWCC SAC Charge �� $ Other. ��''� Fee $ '� On Site Spetic System Fee $ After-the-fact Investigation Fee $ ACKNOWLEDGEMENT TOTAL State Surcharge: Fee $ • �� 'Ihe undersigned hereby acknowledges receipt of this limited permit, i�luding a�ptance of all special infom�aUon, terms, conditions � Total Amount Paid to City Fee $ � reqwrements written above. The uhdersigned underslands and agrees under penalty of law that this permit is strictly limited in scope to the work, � ��, O O activity or improvement specified;that this pertnit dces not grnnt any �� suthority W do work or activities requiring separate permit approvais;and ttiat this pertnit dces not grant suthority to vidate any provision dany City ordinance or State Iaw,rule or regulaoon.All work shall be done in strict '�permit is not valid unt�the proper fee is paid and it is apgroved �mdiance with all City ordirmnms, bm7di� code.s and/or healdi b AII all�lOt1ZC(�Cl �Cl�. department►egulations,and shall be subject to inspection,approval or y ty rejection by the City.Whenever so ordered,the undersigned agrecs to correct any work found to be in violation of the wndioons of this permit. Signature of Applicant _ ' Signature City O�cial �� Code: White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt { F ..._..___ .._ ,.........., cax a lu�\.taxxvs+ i�V' �Lvl� t.ut'Ut.a t Box 66 (1335 Brown Road South ) � � �? �� Crystal Bay, MN 55323 r - � `_�� ****************************************************** � �************'; �General Znformation *� r ... �. �� r....,1 - "� ' ( ' 1. You may apply for plumbing permits by mail or in person at the City of ' . �"� �� :5 ,R� 2. Mailed in application are subject to the postage and handling fees shown bel Permit Cards will� ;i� be sent by return mail the same day the application is received. �� w �i� 3. Permits are not valid until you receive a permit card. --�� ._;� 4. Work must not begin until the permit card ia posted on the job site. 5. Plumbing permitsmay beissued to state-licensed plumbers or to homeowner/occupanta w o actually perform their own work in their home. 6. When any new construction or remodeling is involved, a separate building permit must be obtained. 7. All work must be done in accordance with the State Building Code Requirements. 8. All work must be inspected before it is covered. Call for inspections 24 hours in advance (473-7357). Instructions. Complete all items on this application. Compute the permit fee. Sign and date the ' certification. Zncomplete applications will not be processed. If you have any questions, call 473-7357. WALK-IN PERMITS--Apply at City Offices, 1335 Brown Road So. (County Rd 146) i MAIL-IN PERMITS--Enclose Fee--Mail to: P.O. Box 66, Crystal Bay, MN 55323 �t�k*******************************�t***�F****�k**�Ir**********�k***************** JOB SITE ADDRESS �/�(f'�% �L-�,-�,x��., �� Occupancy Type: �/" Residential Commercial Work to be Performed by: Licensed Contractor Owner/Occupant OWNER'S NAME ,��li/�'�� - ��Q�,,�jv,�'•, Telephone No. Mailing Address PLUMBER'S COMPANY NAME � l' � i`� � ! Bu s i n e s s No. � '� ` <��-'t�� Mailing Address � , � „ S' � Master Plumber ' s State License No.��J/�'�� City Cert. No. **************************************�* ********************************* PLUMBING FIXTURE SCHEDIILE (Show Number of Fixtures of Each Type on Each Floor ) FZXTURE TYPE BSMT. lst Floor 2nd Floor Other Floors FIXTURE TYPE � BSPIT. lst Floor 2nd F1oor � Other Floors Water Closet / Laundrv Tra Lavatorv Wa�sher � Bathtub , � _ Water Heater Shower � Watec Softne� � Kitchen Sink _� _ Misc. Fixtuzes: j Dis�osal (List) � Dis:;•«as.`.er wet Bar ` Sillcocks F1oor Drains I Sum Pumo Sewer Eiectoz I TOTAL VUMBER OF F2XTURES 7k**�F*7k�k***�k****�Ir7k*�k7k***ir*****7k*7k1F******'*7k7k�k*7k7k***1F�k�k*7k7k****7k*7tiF�t***7k***�k7k7k PERMIT FEE CALCULATION l . Fixture Fee. The minimum permit,. fee is $25 . 00 . , / C�' Compute number of fixtures _� x $4/fixture $ �S 2 . State Surcharge $ , �p 3. Postage and Handling (Only for Mail-in applications) $ 1. 50 �� 4 . TOTAL Permit Fee (Add lines 1-3 above) $ - � ************************************************************************** The undersigned hereby applies to the City of Orono 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 Minnesota state Building Code, anc� certifi that all sta ements made on this application are complete, true and correct� .: , . �� .� /�''��;�/'.�', '>: Signature Applic ate i � _ CITY OF ORONO CALLED IN /Q�a�TE�� ,�M�� INSPECTION NOTICE SCHEDULED I v�� '3 PERMIT NO. connP�ErE� Iv z5�� -�- ADDRESS %U S �oY� n e. / OWNER � � CONTR. �S TELEPHONE NO. �o �? �,� ❑ FOOTING � P�UMBINC RI O SITE INSPECTION ❑ FRAMING O PLUMBING FINAL ❑ EXCAV./GRADING/FILLING � ❑ INSULATION ❑ MECHANICAL ❑ LAKESHORE/WETLANDS � ❑ WALL BD. ❑ WATER HOOKUP � LICENSING LL ❑ FINAL O METER SET/TURN ON ❑ COMPLAINT � O PROGRESS ❑ SEWER HOOKUP � FOLLOW-UP � ❑ DEMOI. ❑ SEPTIC INSTALL. O SEPTIC FINAL Q ❑ FIRE PREV. � SEPTIC MAINT. O FIREPLACE/WOOD BURNER Z � WELL TEST PUMP O � COMMENTS: ��-G��v� � �1,r i��s�i C�. ,� W I � L L � � �--s 0 � � W a � J O � � O � W � Q � Z W � W � � d W � W ORK SATISFACTORY:PROCEED O PHOTO TAKEN � CORRECT WORK&PROCEED U ❑ CORRECT WORK CALL FOR REINSPECTION BEFORE COVERING '� CORRECT UNSAFE CONDITION WITHIN HOURS.INSPECTOR WILL RETURN. ❑ STOP ORDER POSTED.CALL INSPECTOR. G INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. cali for the next inspection 24 hours in advance. Owner/Contr. o site Inspector � 473-7357 White/Inspector's File Canary/Site Notice