HomeMy WebLinkAbout2016-00659 - plumbing � CITY OF ORONO * 2 0 1 6 - 0 0 6 5 9 *
�, 2'150 KELLEY PARKWAY DATE ISSUED: 06/08/2016
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 1980 SIXTH AVE N
PIN : 27-118-23-42-0004
LEGAL DESC : LJNPLATTED 27 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURE
NOTE: REPLACE: 1 DISHWASHER
VALUATION OF PLUMBING 1000
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.50
ECOWATER MAIL-IN FEE 2.00
3208 FIRST STREET S
WAITE PARK,MN 56387- TOTAL 52.50
(320)251-2505 Payment(s)
Minnesota State License#:plbg-PC643402 CREDIT CARD 2893 52.50
OWNER
KASHKARI,NEEL
1980 SIXTH AVE N
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be perfortned according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and dces
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming 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.
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Applicant Permitee Signature Date Issued By Signature Date
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FOR C['i'Y L1S�:diVLY
',� City of Orono q
{/ �'�'fi�` P.4.Bax 66 Date Receiv�ed:�Ig ��Pennit H Z��+6 ' ��P /
`f�.�„ �� ?750 Kelley Parkaay .��. z . �
�� �*� Cn�stal t3ay.MN 55323 Approved By: �Amount$:
�«��f,����� (9i2)249-AG00-Main
���� (952)249-:1616-!'as
� CITY OF ORONO—PLX7MBYNG PERMIT
(Ali Commercial Permits Must be Approved by the State Prior to City Approval)
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GENERAG INFORMATION
i. You may apply for plumbin�permits by maii or in person at the City offices. Applications will be
reviewed and a permit wip be issued within two working days.
Z. Permit cards wil[be sentby return maiFafter a review is completed. PERMITS ARE N07
VALID UNTIL YOU RECElVE A PERMIT. WORK MUST NOT BECIN UNTIL TNE
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 dwellin�.
a. 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.
G. All work must be inspected and air tested before it is covered. Call(952}249-4G00.
(2�3-48 hour notice required)
TYPE OF PERMIT
Check All That A I
�Residential ❑Commercial(Approval Required}
❑New ❑Additional ❑Repairs �Replace
❑ In Accessory Structure?
*You rrill necd nrior apnroval and may need CUP.(Per Orono Ciry Code,Chapter 78,Article IV)
Job Site/Owner Information:
Site Address: � ��} � .�,J Uh * L� �� � /v
Owner: N.C�� �4S�i �r�t Mailing Address: !q&� GUvti�� l�rrl � y'`'�
City: ��'K!- Zip: ���� J ��Y�
Home Phone: `�17-3 S;S" �?0�� Alternate phone:
Contractor Information:
,
cpntra�tor: Ecowater Contact Persan: TOCICI
Address: 3208 First Street South State Bond#: PC643402
c�ty: Waite Park Zip:5�87 Expiration Date: �2�31/13
Phone: (320� 251-2505 Alternate Phone:
0 Insurance—Current: Yes
t
�
s ` PLUMBING FIXTURES�BEI�I�TNSTAT:�ED;,
FIXTURE BSMT I' 2' OTHER FIXTURE BSMT 1` 2' OTHER
TYAE FL FL TYPE FL FL
N�ater Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher ) Wet Bar
�
Siilcocks Miscellaneaus
,' PERIV�C��EE C�I,�C�TLAT�IOI�T�S} °: -
t BASEI?OFF`=�20(?2�S'I`A'TE STA'TIIE '
❑ Yes, is section applies
The replacement of on e Residential tixture or an�liance that meets all ree- e foUowing
requirements:
1. Dces not require modifica" to el ' al or gas service.
2. Has a total cost of 5500.00 0 •excludin the cost of the fixtore or apptiance:and
3. ls improved,installed placed by homeowner or licensed plumbing contractor.
Skip next on,if this applies; Cost o it S I5.00
State Surchar $ 5.00
__ �..- Mail-[n Fee(tf Ap licable) $ 2.00
Total Permit Fee� �
(Permit Fees Continued On Next Page)
2
� '
PERMIT FEE CALCU�.�TION S .t.-��OBS:4VER$500.00 :
If above does not apply;foilow guidelines below:
1. CONTRACT PRICE *is 1:?5%0 of cantract price with a(Minimum Fee of$50.00)
�L x.0125$ �� ��
(contract pricc"j (minlmum S.5Q.00)
2. STATE SURCHARGE ��,�
x.Q005 $ � ��
tconimct price)
3. POSTAGE&HANDL[NG(�nly on Mail-In Applications) $ ?.04
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S� ��--� ��
• * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount char�ed for ihe
permitted work including materials,labor,pro�t,and other fixed costs. ft 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,tenani 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 af the job cost, the City may request the submission of a signed copy of the actual contract.
PLUMBING PERMIT`APPlrCAT10N AGREEIvIENT '
The undersigned hereby applies to the Ciry for issuance of a A�umbin� Permit, agrees to do all
work in strict accordance with the ardinances of the City and the regulations of the State of
Minnesota, and certifies that all statements made on this application are camplete, true and
correct.
Applicant's Signature: r/ f Date: (n �'—"�"��� ,
Reset Form
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