HomeMy WebLinkAbout2012-01133 - vacuum breaker CITY OF ORONO * z B l z - 0 i 1 3 3
2750 KELLEY PARKWAY DATE ISSUED: 11/07/2012
r ORONO, MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS 1560 TANGLEWOOD RD
PIN 26-118-23-32-0012
LEGAL DESC TANGLEWOOD
LOT 003 BLOCK 001
PERMIT TYPE PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : VACUUM BREAKER
NOTE: 1"VACUUM BREAKER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
EASCO PLUMBING&HEATING INC. STATE SURCHARGE PLBG(<$500) 5.00
7965 PIONEER TR
LORETTO,MN 55357 TOTAL 20.00
(612)369-5486 PAID WITH CC# 3448
OWNER
BUHMAN,DION&TANYA
1560 TANGLEWOOD RD
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 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 t any time after work has commenced.
The applicant is respo a for assurin II required inspections are
requested i an
with the State uilding Code.This permit may be
revok at ime for due cause.
plic t Pe ' Signature Date Issuedby Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
y FoG 'VI SE ONLY
0City of Orono f ` %
O4 �� P.O.Box 66 Date Received �' �rermit# � / ✓
�. 2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By. Arnount 1t
(952)249-4600—Main
(952)249-4616—Fax
CITY OF ORONO — PLUMBING PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
http://www.dli.mn.2ov/CCLD/PDF/pe plumbplanrevapp.I odf
GENERAL *WORMATION
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 two 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.
3. Plumbing 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 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.
(2448 hour notice required)
TYPE OF PERMIT
Check.All:What A- 1 )
Residential ❑Commercial(Approval Required)
❑ New ❑Additional ❑ Repairs ❑ Replace
❑ In Accessory Structure?
*You will need prior approval and may need CUP. (Per Orono City Code,Chapter 78,Article IV)
Job Site[Owner Informations
Site Address: 1 S(P O ( U,\a C-�
Owner: [ u r>y ti 3 u �, nA(,;'L Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor information:
Contractor: Ea S c o Contact Person:
Address: 71 d n eer r— State Bond#:
City: Zip: 91V Expiration Date:
Phone: (p�a 3 cl S L/�� Alternate Phone:
❑ Insurance—Current:
1
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PLUMBING FIXTURES BEING INSTALLEI
FIXTURE BSMT 1 2 N11 OTHER FIXTURE BSMT 1 2 ND 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
Dishwasher Wet Bar
Sillcocks Miscellaneous
I VUC ung
474 4
I
. ERMIT FEE CALCULATIONS)
BASED OFF - 2002 STATE STATUE
❑ Yes,this section applies
The replacement of only one Residential fixture or appliance that meets all three of the following
requirements:
1. Does not require modification to electrical or gas service.
2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance: and
3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $
(Permit Fees Continued On Next Page)
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.r
If above does not apply; follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
x.0125$
(contract price) (minimum$50.00)
2. STATE SURCHARGE
x .0005 $
(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 furnished 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.
UMBING PERMIT APP LI N AGMEME „'
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
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