HomeMy WebLinkAbout2004 - P07788 - vacuum breaker PERMIT
CITY OF ORONO
Permit Number:
2150 Kelley Parkway - PO Box 66 P07788
Crystal Bay, Minnesota 55323 Permit Type: Vacuum Breaker
(952) 249-4600 Date Issued: 8/4/2004
SITE ADDRESS: 1770 West Farm Rd
Long Lake,MN 55356
PID: 27-118-23-44-0017
DESCRIPTION:
Proposed Use: Kesidentiai
Permit Class: Plumbing
Permit Type: Vacuum Breaker Permit Sub-type(s): Plumbing Undefined
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Installed PVB-Sprinkler System
FEE SUMMARY: Permit Fee: $ 15.00
Valuation: $ 0.00
State Surcharge Fee: $ 0.50
Misc. Fee: $ 1.50
TOTAL FEE: $ 17.00
APPLICANT: Roto Rooter Services Co. OWNER: Sherry G Patterson
14530 27th Ave.N. 1770 West Farm Rd
Minneapolis,MN 55447 Long Lake,MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE 4' ED BY SIGNATURE
Conies: 1-File(Signitures Required), 1-Applicant. 1-Monthly Reports. 1-Assessing, 1-Finance Page 1
Sap-04-2003 12:06pm From-CITY OF ORONO +9522494616 T-093 P.002/003 F-778
4
CITY OF ORONO APPLICATION FOR PLUMBING PERMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, 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 CART)IS POSTED ON
THE JOB SIM
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 obr2inrd.
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. Call (952) 249-4600. 24-hour notice
required.
Instructions Complete all items on this application. Compute the permit fee. Sign and date the
certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have
questions, call (952) 249-4600.
Please check one: New Addition Repair Replace
k• Residential Commercial
JOB SITE: 1 r ?0 Li&rn Ft.o a 1 Zip: 5-5' 351,
Owner's Name: sN.,,tR ► Dwt i�. r611/ -Telephone Number:_
Mailing Address: 1'7?e) Fit-ar)n P oa City: p Rb N o Zip; '$SL
Contractor's Name:,(4 4.h.. R m 0 4 tJ�. _ Telephone Number; '76 3_r1 Q_3 40 y
Mailing Address: (4 ss3 0 -p..01-11- 4r.e_N City: p Aev14 Zip: 5-6-447
PLUMBING FIXTURE SCHEDULE
FIXTURE 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
Dishwasher Wet Bar
Silicocks Misc (list)
'‘r ENt'Q
Sep-04-2003 12:06pm From-CITY OF ORONO +9522494616 1-093 P.003/003 F-778
PERMIT FEE CALCULATION(S)
2002 State Statute Yes, This Section Applies
The replacement of a Residential fixture er 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 licenced contractor.
Skip next section; Cost of Permit $ 15.00
State Surcharge $ .50
Mail In Fee $ . 1.50
If above does not apply, follow guidelines below:
1. Contract Price* is .0125 % of job with a Minimum Fee Qf($35.00)
x .0125 $
(contract price) (minimum$35.00)
2. State Surcharge_ ** Add the State Building Code Division a (Minimum Fee of$ .50)
x .(0)5 $
(contract price) (minimum$ .50)
3. postage and Handling (Only mail-in applications) $ 1.50
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 tht zmount to be charged to the customer
for the work done. If any material, equipment, labor,or installation 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 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 Inspection 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: j4 j J4 Date: OSA b