HomeMy WebLinkAbout2018-00059 - plumbing CITY OF ORONO 1 I I I 11I 11 I I I 111 111111
*
2750 KELLEY PARKWAY * 20 1 8 - 000 9
DATE ISSUED: 01118/20182018
ORONO,MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 4160 FOREST LAKE DR
PIN : 07-117-23-11-0003
LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN
: LOT 004 BLOCK 001
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURES-MULTIPLE
NOTE: (3)WATER CLOSETS,(4)LAVATORIES,(1)BATHTUB,(1)SHOWER,(1)KITCHEN SINK,(1)DISPOSAL,(1)DISHWASHER
VALUATION OF PLUMBING 3000
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 1.50
LEGEND SERVICES, INC TOTAL 51.50
P O BOX 382
LORETTO,MN 55357- Payment(s)
(763)479-5002 CHECK 8651 51.50
Minnesota State License#:plbg-PC644501,mech-MB005090
OWNER
CLINE,JUSTIN&HOLLY
4160 FOREST LAKE DR
MOUND,MN 55364-
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.
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A cant'P�ftnite Signature Date Issued By Si Lure Date
Jan 18 18, 11:52a p.2
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City of Orono
P.O.Box 66 FOR C IT% Q
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2750 Kelley Parkway Date Received:^� // C"�T {{
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t Crystal Bay,MN 55323 Permit#
7 j (952)249-4600—Main
e'°KFS>io0.e (952)249-4616—Fax Approved By:
Amount$: /, O
CITY OF ORONO —PLUMBING PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
http:l/www.dli.mn.gov/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:0 AVB Q PVB]
❑ New ❑Additional
❑ Repairs Ar.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: Irl [Aire_
Owner. S;w 4- iiityt.L.y at e- Mailing Address: 5-akip ,a-s 440 ve
City: c9 a2o 0 Zip: 5536/
Home Phone: Alternate Phone:
Contractor Information:
Contractor: L.e .*.d vices - -" Contact Person: 1 t
Address: � L x 30i_2 "
State Bond#: PCyySQ/
City: _ L d9, Zip: .c.5351 Expiration Date: 1�f //,�01
,F
Phone: 763- /7 t-SDS' .Z
Alternate Phone:
nsurance— Current: Aro Cvvte4-5
Page 1
Jan 18 18, 11:52a p.3
PLUMBING FIXTURES BEING INSTALLED
FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2NO OTHER
TYPE Floor Floor TYPE Floor Floor
Water Closet I ., Floor Drains
Lavatory t 3 Sewer Ejector
Bathtub Laundry Tray
Shower 1 Washer
Kitchen Sink I Water Heater
Disposal ) Water Softener
r
Dishwasher ) Wet Bar
Sillcocks Miscellaneous
PERMIT FEE CALCULATION
1. CONTRACT PRICE *is 1.25%of contract price with a (Minimum Fee of$50.00
ivx.0125 $ r 4 1 tro
()t ontract price) (mini • m $50.00
2. STATE SURCHARGE
x .0005 $ I. C°
(contract price)
3. POSTAGE & HANDLING(Only on Mail-In Applications) $ k5C1.
4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ ,,�0 5l 5V
* 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 1
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: 144�/ 0y1-e--e( Date: 1- /dO-/fi .
Building Official/Inspector. Date:
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