HomeMy WebLinkAbout2012-00621 - backflow device only CITY OF ORONO * 2 0 1 2 - 0 0 6 2 1
2750 KELLEY PARKWAY DATE ISSUED: 06/29/2012
ORONO, MN 55356-
(952) 249-4600 FAX: 952 249-4616
ADDRESS : 724 TONKAWA RD
PIN : 05-117-23-34-0003
LEGAL DESC : PARTENS POINT 1 ST DIV
: LOT 010 BLOCK 000
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE BACKFLOW DEVICE ONLY
NOTE:
BACKFLOW PREVENTER IRRIGATION
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
WELD&SONS PLUMBING CO INC. STATE SURCHARGE PLBG(<$500) 5.00
3410 KILMER LANE N
PLYMOUTH,MN 55441- MAIL-IN FEE 2.00
(763)475-0296 TOTAL 22.00
PAID WITH CC# 5676
OWNER
ZAWOYSKI, STEPHEN& SARA
724 TONKAWA 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 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 tim�rdu
cause. (Pl 2 9
Applicant Pen, ee Signature Date Issue y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
06/28/2012 11:11 7634752566 PAGE 02/05
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(952)249.4616—Rax
CITY OF ORONO—PLUMBING PERMIT
(All Commercial.Permits Must be Approved by the State Prior to City Approval)
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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. Pennit 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)249-4680.
(24-48 hour notice required)
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®Residential ❑ Commercial(Approval Required)
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❑New ❑Additional ❑Repairs ❑Replace
❑ In Accessory Structure?
*You will need prior approval and may need QR,(Per Orono City Code,Chapter 78,Article IV)
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Site Address: -724 —15 Nola wa- a t
Owner: �. e_f &y9 Za Wot.slur" Mailing Address: -4583 "Vieul Ot;V e�_
City: Zip: 555!24
Home Phone: g 47' 3 23' 49 4 Alternate Phone:
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Contractor: We[d 4-_C�-*nS pI GcM 4;)2) Contact Person: ,&
Address: 3 1) J41 WW- " N, State Bond
City: wtocc' Zip: 55yqf Expiration Date:
Phone: M3)`f'757 Q 22G 1 Alternate Phone:
[� Insurance-Current:
1
06/28/2012 11:11 7634752566 PAGE 03/05
FLXTURE BSMT 1'4-' 2 OTHER FIXTURE BSMT 1 2 NU 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
P�I> -
Ztir�„�toz-•.
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❑ Yes,this section applies
The replacement of only one&Midential fixture o_r a liance that meets all three of the following
requirements:
1. Does no require modification to electrical or gas service.
2. Has a o c t of$500.00 or less;excludin 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 Foe(If Applicable) $ 2.00
Total Permit Fee $
(Permit Fee%Continued On Next Page)
2
06/28/2012 11:11 7634752566 PAGE 04105
If above does nota apply;y,followidclines below:
� �I
1. -CONTRACT PRICE ' is 1.25%of contract price with a(Minimum Fee of$50.00)
x-01.25$
(c'"tmci price) (minimum$50.00)
2. STATE SURCEIAR__Og
x.0005 S
(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.
The undersigned hereby y appttes to the City for issuance of a Plumbing Permit, agrees to do all i
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 Signatu Date:
I
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