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Home My WebLink About2017 - 00003 - plumbing CITY OF ORONO 1 11 * 2 0 1 7 - 00003 * 2750 KELLEY PARKWAY DATE ISSUED: 01/05/2017 ORONO,MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS : 200 WOODHILL RD PIN : 02-117-23-12-0001 LEGAL DESC : UNPLATTED 02 117 23 : LOT 000 BLOCK 000 PERMIT TYPE : PLUMBING PROPERTY TYPE : COMMERCIAL-BUSINESS CONSTRUCTION TYPE : FIXTURES-MULTIPLE NOTE: (2)WATER CLOSETS,(4)LAVATORIES,(4)SHOWERS,(12)FLOOR DRAINS VALUATION OF PLUMBING 12000 APPLICANT PLUMBING FIXTURE FEE 150.00 STATE SURCHARGE PLBG(VALUATION) 6.00 PAVEK PLUMBING TOTAL 156.00 4550 COUNTY RD 10 N Payment(s) WATERTOWN,MN 55388 CREDIT CARD 9574 156.00 Minnesota State License#:BUIL-60617-PM OWNER CLUB, WOODHILL COUNTRY 200 WOODHILL RD WAYZATA,MN 55391 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 time for due cause. Applicant Permitee Signature Date Issued By Signature Date CITY OF ORONO I 11141111 11II 11111111111 * 2 0 1 7 - 00003 * 2750 KELLEY PARKWAY DATE ISSUED: 01/05/2017 ORONO, MN 55356- (952)249-4600 FAX: (952) 249-4616 ADDRESS : 200 WOODHILL RD PIN : 02-117-23-12-0001 LEGAL DESC : UNPLATTED 02 117 23 : LOT 000 BLOCK 000 PERMIT TYPE : PLUMBING PROPERTY TYPE CONSTRUCTION TYPE : FIXTURES-MULTIPLE NOTE: (2)WATER CLOSETS,(4)LAVATORIES,(4)SHOWERS,(12)FLOOR DRAINS VALUATION OF PLUMBING 12000 APPLICANT PLUMBING FIXTURE FEE 150.00 STATE SURCHARGE PLBG(VALUATION) 6.00 PAVEK PLUMBING TOTAL 156.00 4550 COUNTY RD 10 N WATERTOWN,MN 55388 Payment(s) CREDIT CARD 9574 156.00 Minnesota State License#: BUIL-60617-PM OWNER CLUB,WOODHILL COUNTRY 200 WOODHILL RD WAYZATA,MN 55391 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 time for due cause. RPetf-C.) / / //7 , urApplicant Permitee Signature Date Issued By nate Date ' �pAr City of Orono FOR CITY USE ONLY / O P.O. Box 66 Date Received: /—� —/ '7 2750 Kelley Parkway Crystal Bay, MN 55323 Permit# c D/ D � c' (952)249-4600—Main kFSHO 1 y� � �'' 4`` (952)249-4616—Fax Approved By: Amount$: / 54. , 0 CITY OF ORONO — PLUMBING PERMIT (All Commercial Permits Must be Approved by the State Prior to City Approval) http://www.dli.mn.qov/CCLD/PDF/pe plumbplanrevapp.pdf GENERAL INFORMATION 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. (24-48 hour notice required) TYPE OF PERMIT(Check All That Apply) ❑ Residential ❑ Commercial (Approval Required) [Backflow Device: ❑AVB ❑ PVB] ❑ 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 Information: Site Address: 2 9O tt)O fe H;/? ti e Owner:tt 4f)((GoU4 IR/.:/4-P/ Mailing Address: City: Zip: �. 3?7 Home Phone: Alternate Phone: Contractor Information: Contractor: f?r/-tr Pkimb_)46-)_ _ Contact Person: [Zia) re? /.( Address: W57-5 --.4771/0-4)/0 State Bond #: City: tea,'4Q (�lc)/1 Zip: 38 Expiration Date: l gtle Pone:2-. ! ss O_� a Alternate Phone: ❑ Insurance — Current: PG 6e7 3.c88 Page 1 PLUMBING FIXTURES BEING INSTALLED _ r FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER TYPE Floor Floor TYPE Floor Floor Water Closet Floor Drains 1‘ Lavatory (1 Sewer Ejector Bathtub Laundry Tray Shower `'i Washer Kitchen Sink Water Heater Disposal Water Softener Dishwasher Wet Bar Sillcocks Miscellaneous PERMIT FEE CALCULATION 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.00) x .0125 $ (coritract 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. PLUMBING PERMIT APPLICATION AGREEMENT 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: c/57/ / Building Official/ Inspector: Date: Page 2