HomeMy WebLinkAbout1998-010555 - vacuum breaker PERMIT
� CF�'�( OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 F`i_���r�������
Crystal Bay, Minnesota 55323 P e r m i t N u m b e r: ;;� t_}V,;�
(612) 473-7357 Date Issued: �_r f�;:�;ti;��:_;
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLIC T/PERMITEE SIGNATURE ISSUED BY:SIGNATURE �
• ,- • �105 S���
C1TY OF URONO APPLICATION FOR PLUMBING PERMIT �
}1oY b6 (27�0 Kelley Parkway)
Crystal Say, 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 RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS
POST�D ON THE JOB SITE.
3. Plumbin�permits may be issued ONLY to licensed plumbing contractors and to property owners residing
in the dwelling.
4. When any new construction or remodeling is involved, a sepazate 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. Ca11473-7357. 24-hour notice required.
Instructioi�� CoalpletP all items on this application. Compute the permit fee. Sign and date
the certificatioii. INCOMPLET� APPLICATIONS WII.,L NOT BE PROCFSSED. If you have
questions, call 473-7357.
Please check one: New �Addition Repair Replace
> ' Residential Commercial
JOB SITE: 3 `-�5 \ Zip: S 3
Owner's Name: ' Telephone Number: .
MailingAddress: ` ity: �1Z d�,.b Zip:55�3 9 �
Contractor'sName: � Te honeNumber: G/2 9�� :j5`�1
MailingA.ddress: / �/.S• � Zip:SS ��-8 ��/G g
PLUMBING N'�TURE SCHEDULE
FIXTURB BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater �
Disposal Water Softener
Dishwssher Wet Baz
Sillcocks isc ist , l
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PERMIT FEE CALCULATION
1. 1.25% of Contract Price* or Minimum Fee ($35.001 �
����-- x .0125 $ ,
(contract price)
2, State Surcharge. ** Add the 5tate Building Code Division
Surcharge to each permit. � - x .0005 $
(contract price) � �
� or $.50, wluchever is greater
3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
4. TOTAL PERNIIT FEE (Add lines 1-3 above) $
* CONTRACT PRICE or JOB COST means the actual or estimated dollaz 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 aze fiunished 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. 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 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 Inspectional 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. 7 �3o Q
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