HomeMy WebLinkAbout2010-00251 - water heater . �
CITY OF ORONO PERMIT NO.: 2010-00251
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE IssuEn: 04/22/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 4250 FOREST LAKE DR
PIN : 07-117-23-12-0022
LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN
: LOT 000 BLOCK 002
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER HEATER
NOTE: WA"C}3R FIEATER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
NORBLOM PLUMBING CO. STATE SURCHARGE PLBG (<$500) 0.50
2905 GARFIELD AVENUE S.
MINNEAPOLIS, MN 55408- MAIL-IN FEE 2.00
(612)827-4033 TOTAL 17.50
OWNER
ETAL, ROBERT DONGOSKE
4250 FOREST LAKE DR
MOUND, MN 55364
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for oniy the work described and does
not grant pemiission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this typc of work
shall be compied with whether or not specified hercin.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended tor a period of 180 days at any time after work has commenced.
The applicant is responsibie for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked any time for due cau .
`-� ' �,(. " �� - - � C1 �
Applicant Per itee Signa ��e Date L� �'� l�o� L7
�� Is By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK HER THAN DESCRIBED ABOVE.
R`CEIV f FOR CITY SE ONLY
�,�` City of Orono ��-` , �,.,
. O4 `�`O P•O.Box 66 Date Reccived�����G�]'ermit# / ��� �-��
+�„��, 2750 Kelley Parkway APR � � •
a ��r� f- Crystal Bay,MN 55323 L�` Approved By: Amount$:�L
. �s �����,��o` (952)249-4600 ^'�
�EB40$' V OF ORONO
CITY OF ORONO —PLUMBING PERMIT
(All Commercia]permits must be approved by the Building Official or Inspector)
GENERAL INFORMATION _
1. You may apply for plumbing permits by mail or in person at the City offices. Applications will be
reviewed and a percnit will be issued within two working days.
2. Pernut 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 properly 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. Cail(952)249-4600.
(24-48 hour notice required)
TYPE OF PERMIT
(Check All That Apply)
� Residential ❑ Commercial(Approval Required)
❑ 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:
Robert Dongoske
Owner: 4250 Forest Lake Drive 3dress:
orono,MN 55364
City:
352��244i3
Home Phone: Alternate Phone:
Contractor Information:
Contractor: N�r��O� aI�(,(�}�b�.1�I� Contact Person: `'�
Address: 2��� �a���d '� S�. State Bond #: ��(' ��� ��
City: � �S ZipS�fb� Expiration Date: I � ��/V /
Phone: f��2`��2'?� �fa��3 Alternate Phone: ��
,.� Insurance— Current:
1
;�;,��.��`^�;,�;;^����;����.�;�I.' ' PLUIVIBTNG FIXTURES BETNGINSTALLED ' -
FIXTiJRE BSMT 1 2 OTH�R PIXTURE BSMT 1 2 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
� PERMIT FEE CALCULATION(S) �
BASED OI'P - 2002 STAT� STATUE ' �
❑ Yes,this section applies
The replacement of a 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$SOU.00 or less; excludin�the cost of the fixture or appliance: and
3. Is improved,installed or replaced by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surcharge $ .SO
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $�
(Permit Fees Continued On Next Page)
2
. .
, �` ' ° ' PERMIT FEE CALCULATION(S =JOBS OVER.$500.00 ' `' ���. ,:
' If above does not apply; follow guideluies below:
1. CONTRACT PR10E * is 1.25%of contract price with a(Minimum Fee of$50.00)
x.0125 $
(contract price) (minimum$50.00)
2. STATE SURCHARGE ** Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50)
x.0005 $
(contractprice) (minimum$ .50)
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
pernutted 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 pernut 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 Building Department at(952) 249-4600 for the price.
�'�'' '�' ` P_L,UMBLNG PERIv1IT APPLICATION AGF.EEMENT '
` ` I
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
Minriesota, and certifies that all statements made on this application are complete, true and
correct.
Applicant's Signature: �� Date: L,� � � �
3