HomeMy WebLinkAbout2004-P07406 (plumbing) CITY OF ORO�10 PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: Po�4o6
Crystal Bay, Minnesota 55323 Permit Type: F�Xtures
(952) 249-4600 Date Issued: 4i2�i2oo4
SITE ADDRESS: 3300 Bayside Rd
L,ong Lake,MN 55356
PID: OS-117-23-14-0058
DESCRIPTION:
Proposed Use: Kesident�al
Permit Class: Plumbing
Permit Sub-type(s): Multiple Fixtures
Permit Type: Fixtures
DETAILS:
Approved per resolution #:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 15.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 15.50
APPLICANT: Steve Santema Plumbing OWNER: Douglas&Jan Humphrey
412 12th Street, Box 92 3300 Bayside Rd
Howard Lake, MN 55349 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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APPL[CANT PI?RMITEE SIGNATURE ISSUEDBYSIGNATURE
Copies: 1-File�Sienitures Repuired), 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
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CITY OF ORONO APPLICATION FOR PLU1biBING 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 o�ces.
2. Permit cazds 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 perm.its 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 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
Residential Commercial
JOB SITE: 33� `�►yS Ii�E 12P• �� �-��i �"�� Zip: 55 3 5�o
Owner's Name: �E 11��ttYN�t Telephone Number: 95 �- y76 -iq i9
Mailing Address: �A►.c.� City: Zip:
Contractor's Name: S�c��E �ctiinp ��c C� Telephone Number: (o f 2-S�b�- r�+q
Mailing Address: yy o'7 Loe.eE AVE. S w• City: Co�ro Zip: 553 2t
PLUMBING FIXTURE SCHEDULE
; FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet � Floor Drains
Lavato ^ Sewer E'ector
Bathtub x Laun Tra
Shower X Washer
Kitchen Sink x Water Heater
Dis osal Water Softener
Dishwasher � Wet Bar
Sillcocks Misc (list)
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PERMIT FEE CALCULATION
2002 State Statute Yes, This Section Applies
The replacement of a Residential fixture or a�pliance 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; excludin� the cost of the fixture or appliance:
and
3) Is unproved, 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:
l. Contract Price* is .0125 % of job with a Minimum Fee of ($35.001
x .0125 $
(contract price) (minimum$35.00)
2. State Surcharge. ** Add the State Building Code Division a (Minimum Fee of$ .50)
x .0005 $
(contract price) (minimum$ .SJ)
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3. Postage and Handling (Only mail-in applications) $ 1.50
5 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 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 Giry 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.
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Applicant'sSignature: Date: �`�,?/—�J�