HomeMy WebLinkAbout2016-00074 - residential � " CITY OF ORONO * Z 0 1 6 - 0 PJ PJ 7 4 *
2750 KELLEY PARKWAY DATE ISSUED: OU20/2016
ORONO, MN 55356-
, (952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1480 SIXTH AVE N
PIN : 26-118-23-32-0008
LEGAL DESC : DOUGLAS ESTATES
: LOT 001 BLOCK 001
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURES-MULTIPLE
NOTE: REPLACE 2 KITCHEN SINKS
VALUATION OF PLUMBING 900
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.45
SAM HENDRICKSON PLBG&HEATING INC TOTAL 50.45
29901 725TH AVE Payment(s)
DASSEL,MN 55325- CREDIT CARD 7507 50.45
Minnesota State License#:plbg-PC646230,mech-MB005006
OWNER
GULBRANDSON,DAN&ERICKA
1480 SIXTH AVE N
LONG LAKE,MN 55356-
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 separa[e
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 c se. -� �
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Applicant Permit ignature Date Issued By Sigtsature Date
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�p� City of Orono PflR��TY Us��1NLY
/ Q P.O. Box 66 C�at�l�4�Biv�d:�,_?�,'y 1�v,._,
2750 Ke�ley Parkway
� Crystal Bay,MN 55323 F'�I'mlt�# •. 'Z'C7 i l.� ��`"�.; �
�'� �` (852)249�600—MBin � ` ` .
�".tESNa�`` Appf�►��d By; � ,
(952)249-4616—Fax �
Amount�� :.�.,, �,. •
CiTY OF QRQNO — PLUMBING PERMII"
(AI! Commercial Permits Must be Approved by the State Prior to City Approval)
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�ENERAL IIVFOI�MA�"1�1N _ , _ ,
1. You may apply for plumbing permits by mail or in person at the City o�ces. Applications will be
reviewed and a permit will be issued within two working days.
2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NQT VALID
UNTIL YOU RECEIVE A PERMIT. WORK MUST NO"f BEGIN UNTIL THE P�RMIT CARD IS
POSTED ON THE JOB SITE.
3. Plumbing permits may be issued ONLY to (icensed plumbing contractors and to property owners
residing in the dwelling.
4. When any new construction or remodeling is involved, a separate building permit must be abta�ned.
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}
Tl(R� ClF ��F�i1►ll'��Ch�c4�',�1!Tha�.A���Y�
�Resid�ntial ❑ Commercial (Approval Required)
❑ New ❑ Additional ❑ Rep�irs ,�Replace
❑ In Accessory 5tructure?
*You will nead rior� roval and may need CUP. (Per Orono City Code, Chapter 78, Article IV)
Job Si#�/�wn�� 1�i�'c�rrri�itidn:
Site Address: �U� �✓ '�' �Vd'���
Owner: U /.1/ �'1 Mailing Address:
City- C��d � O Zip:
Home Phone: Alternate Phone_
Cqntrac��r Infs�rrn�tion:
Contractor� ��c� !� � Contact Person��, �r ���G�-Sdy7 _
Address: a� �- State Bond #;J��l� '��O�-��
Cit : �� �-- Zip�-�� Sr Expiratipn Date;ra� � �
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Phone: ��� �� Alternate Phone: 4�" / �� /'`�
❑ Insurance— Current: T�j
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FIKTURE BSMT 1sT 2ND QTHER FIXTURE BSMT �sT zND pTHER
TYPE Floor Floor TYPE Ffoor Floor
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink �, Water Heater
Disposal Water$oftener
Dishwasher Wet Bar
Sillcocks Miscellaneous
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1. GONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of 550.00)
�d�, � x_Q125 $ ��i d�
� (contract price) (minimum $50.00)
2. STATE SURCHARGE
Gv' � x .0005 $ ' y�
(contract price)
3. POSTAGE 8� HANDLING (Only on Mail-In Applications) $ 2,00
4. TOTAL PERNEIT 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 ta be chargsd to
the customer for the work done. If any material, equipment, labor or installations are furnished by the
nwner, tenant or any other party, the rsasonable market value of such items must be added to the
estimated cost or contract price for permit fee purposes. I� the event that there is a dispute on the
8mount of the job cost, the City may request the submission of a signsd copy of the actual contract.
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The undersigned hereby applies to the City fot issuance of a Plumbing Permit, agrees to do all work in
strict accorda�ce with the ordinances of the City and the regulations of the State of Minnesota, and
certifies that all statements made on this application ar complete, true and coRect_
Applicant's Signatur . ` Date: J
Ruilding Official/ Inspector: Date:
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE�,, / SCHEDULED ������7'� �
PERMIT NO. 7` COMPLEf
ADDRESS _� �
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OWNER TELE E NO.
CONTRACTOR
� DESCRIPTION
ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL Q��ING RI ❑ EXCAV/GRADING/FILLING
Q ❑ FOUNDATION WATERPROOF LUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
? ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
J ❑ DEMO-SITE ❑ SEPTIC INSTALL
2 OWNERICONTRACTOR TO MEEi YiOU:_YES_NO
v�, COMMENTS:
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� ❑WORK SATISFACTORY:PROCEED OJECT COMPLEfE
w ❑CORRECT VYORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. � 2 49-46��
OwnerlCoMractor on site:
Inspector:
White CopyAnapector's Flle Canary CopylSite Notice