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FOR CITY USE ONLY
� City of Orono I
�OW
t P.O.Box Date Received: /Ip//3 Permit# 0/0/3-'01026
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By: Amount$:
(952)249-4600-Main
> (952)249-4616 Fax
CITY OF ORONO -PLUMBING PE'
kSHo - (All Commercial Permits Must be Approved by the Sta , nor to City Approval)
http://www.dli.mn.gov/CCLD/P F/ e i •mb lanreva) ..cif
GENERAL INFORMATION
1. You may apply for plumbing permits by m *l .- son at the City offices. Applications will be
reviewed and a permit will be issued withi V ,orktng days.
2. Permit cards will be sent by return mail aft review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PE' . WORK MUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON T- JOB SITE.
3. Plumbing permits may be issued O► Y to licensed plumbing contractors and to property owners
residing in the dwelling.
4. When any new construction o emodeling is involved,a separate building permit must be
obtained.
5. All work must be done i ccordance with State Code requirements.
6. All work must be insp ted and air tested before it is covered. Call(952)249-4600.
(24-48 hour notice r quired)
TYPE OF PERMIT
(Check All That Apply)
1=1 Residential a7 ommercial(Approval Required)
❑ New ❑ Additional ❑ Repairs 111'eplace
❑ In Accessory Structure?
*You will need prior approval and may need CUP. (Per Orono City Code, Chapter 78,Article IV)
Job Site/Owner Information: ( iqo Site Address: 20 C' a/ ` � / /'/ 4/15 l
Owner: 8raJ jE((C c7 c\ Mailing Address: 2`( Aad /( -1 k / 'f
City: me"( / - Zip: 5-5-3 .
Home Phone: ? 3 4( ?3 5 6d ( Alternate Phone: C 7Z q 90 2-3 7I
Contractor Information: //
Contractor: "Era E rfics� Contact Person: . '/ -
ei
Address: � ' fr State Bond #:
City: 7)/e1/H ei Zip:5-53x6 Expiration Date:
Phone: ' 76.3 C(73 c 1p8 ( Alternate Phone: 67Z IN 0 73 2(
I I Insurance-Current: If e 5
1
PLUMBING FIXTURES sBE1NG INSTALLED;
FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT lsf 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet N Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous
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❑ 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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PERMIT FEE CALCIJLATION(S)''-.',JOBS OVER$500.00
If above does not apply; follow guidelines below:
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00)
/ 3o x .0125 $
(contract price) (minimum$50.00)
2. STATE SURCHARGE
/�O
l 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.
PLI MBINGP R }APPLICA i ' °t-<,rR ME T
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: L` ' �/ (
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