HomeMy WebLinkAbout2013-00612 (Water Softner) � CITY OF ORONO *2013-00612*
' 2750 KELLEY PARKWAY DATE ISSUED: 07/03/2013
ORONO,MN 55356-
(952)249-4600 FAX: (952 249-4616
ADDRESS : 1250 ARBOR ST
PIN : 10-117-23-31-0106
LEGAL DESC : CRYSTAL BAY MINNETONKA
: LOT 0 BLOCK 0
PERMTT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER SOFTNER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
CULLIGAN SOFT WATER SERVICE CO. STATE SURCHARGE PLBG(<$500) 5.00
6030 CULLIGAN WAY
MINNETONKA,MN 55345 MAIL-IN FEE 2.00
(952)912-7379 TOTAL 22.00
PAID WITH CC# 0597
OWNER
ENGEBRITSON,REGINA
1250 ARBOR ST
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not gant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked ai any time for due c2use.
�� � � � i i
Applicant Permitee Signature Date Issued By gnature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED .
07/03/2013 12:45 FAg 9529335049 CULLIGAN �1TRA C�002
FOR CTCY USE OPiLY
� City of Orono pata Received: 1'ermit#�
�'� �O P.O.8ox 66
� 2750 Kelley Parkway Approved By: Amount$:
'St •�L Crystal Bay,MN 55323
� ��� (952)244-Q600
CITY OF URONO—PLUMBING PERMT['
(All Commercial persnits muat be approved by the Building O�ciel or Inspector)
GEr���ox�.TTON
1. You may apply for plumbing permits by mail or in person at the City o�ces. Applications wiil'be
reviewed and a permit will be issued within two working days.
2. Permit cards will be serit by return mail after a review is comPleted• pERMITs ARE NOT
VALm UNTII.YOU RECEIVE A PERMIT. WORK MI7ST NOT BEGIN UNTT]L THE
ET�MIT CARD IS POS'TED ON THE JOB SITE.
3. Plumhing permits may be issued ONLY to licensed plumbing contractors and to property owners
residing in the dwelling.
4, When any new construction or ramodeling is involved,a separate building permit must be
obtained.
5. AlI work must be done in accordance with State Code reqairements.
6. All work must be inspected and air tested before it is covered. Cail(952)249-46Q0.
(2448 honr notice required)
TYPE OF PERMIT
Check Al1 That A 1
�Residential ❑Commercial(Approval Requirec�
�]New ❑Additional ❑Repairs ❑Replace
-�\
❑ 1n Accessory Siructure?
'�Yau wYll need rior a roval and may need CLJP.(Per Oronu City Code,Chapter 78,Article f V)
Job Site/Owner Information:
Site Address: ��� ���'� `�
Owner: o� .nk �n���r� �S o v� Mailing Address:
City: Zip: S5 3�t �
Horne Phone: _.��a - q� � ' �`r; � Alternate Phone:
Contractor Information:
Contractor: Contact Parson: �"�'
����,{a p�N WArtER�N� YlONI�tG State Bond#:
A �'Q�0 GUU
N{INNETONKA, MfV 55345
� City: (9�2� �33-72�0 Zip: Expiration Date:
Phone: Altemate Phone; 9'Sa-`��a " �� �1
❑ Ir�suzance—Current:
1
07/03/2013 12:45 FAg 9529335049 CULLIGAN �NTRA �J003
•r.; • �.r:+ '' '•. ' ' �'�`� ..µµ,, °�'�t� dJ,�,1I�3�•;•/i►1:i3�+�W,!a�-,��i"` . y:":,'.y.+.
•,')�; ,�n^•77'��b�'�+�`�`��,1�'L�.' ..P i e •�+}w•�� "°�`t:'
`.;,. ��r..
FI}(TiJRE BSMT 1 2 OTHER FIXTURE BSMT �,L FL O��R
Typg FL FL 'I'YI'E
Water Closet Floor Drains
Lavatory Sewer Ejector
B��b . Laundry Tray .
Shower W�h�
Kitchen Sinlc Wa#er Heater .
Disposal Water 5oftener +
�
Dishwasher w�B�
Sillcocks Miscellanaous
1 ` y � � ��. •: ` . 1 j.. `'.. .{i� L• �`Y:� i �'�'p N.. 1''ly 4
� ,}�g �3C" ir �I` 9r ��«y ,1 at+W+��°'�� �L�{ y,
' `�, �`l��•J+.�i���� y�.d6 ��•a •�U��Tr•�J�+��w.li i��i'IJi��d�a.��t'!
r
�.Y.'�.� t..nr t" .
❑ Yes,this section applies
The replacement of a Residential f�ctu or a liance that meets all three of the followieg requirements:
1. Does not requira modification to elecirical or gas service.
2, Has a otal co of$SQ0.00 or less;excludins the cost of the fiycture or appliance:and
3. is improved,installed or replaced by the homeowner or licensed conlractor.
Skip next section,ifthis applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) � 2.Q0
Total Permit Fee $
(Permit Fees Continaecf On Next Page)
2
07/03/2013 12:45 FA% 9529335049 CULLIGAN �NTRA C�004
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F �ih,`'���F'� ,.`� � }. _ •1xl �.��'.���,�;e •,�'��'1.V'i�Js�t•iti:l�'!1'',j. '.� �I�e
t'iit�,#,'-v«'.'���';ii:•:.;;£a rr� ir,
If above does not appty;foilow guidelines below:
1. C(�NTRpCT pRICE *is 1.25%of contract prica with a(Minimam Fee of$50.00)
x.0125$
+ (contract price) (minimum$50.00)
2. STA'l�SURCkIARGE **Add the State Bidg Code T7iv.Surcharge(Minimum Fee of$5.00)
x.0005 $
{contract price) (minimum$ 5.00}
3, POSTAGE&HANDLING(Only on Mail-In Applications) $ 2•0�
4. TUTAL PERMIT F'EE(Add Lines 1-3 Above) $ aa• � �
■ * CONTRACT PRICE or JOB COST means the ac�al or estimatsd dollar amount charged for the
permitted work including materials,labor,profit,and other fixed costs. ]t is the amount to be charged
to the customer for the work done. Tf 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 purpases. In tha event that there is a dispute on the
amount of the job cost,the City may request the submission of a signal copy of the actuat contract.
■ *�'The STATE SURCHAR.GE is.0045 of the contract price under$1,000,00Q or$5.00—whichever is
greater. For valuations over$1,000,000 cal!thc Building Department at(952)249-4600 for the price.
,
� � � _
The undersigned hereby applies to the City for issuance of a Plambing Permit, agrees to do all
work in strict accordance with the ordinances of ttie City and the regulations of the State of
Minnesota, and certifies that all statements made on this application are complete, true and
correct.
' i nature: � Date•
Appl�cant s S g
a ,,. ., u .
3