HomeMy WebLinkAbout2010-00321 (plumbing) - CITY OF ORONO PExM�T�vo.: 2010-00321
� 2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE IssuEn: 05/07/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 3770 BAYSIDE RD
PIN : OS-117-23-24-0121
LEGAL DESC : OTTOVILLE ON LAKE MTKA
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER SOFTNER
NOTE: WATER SOFTENF,R
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
CULLIGAN SOFT WATER SERVICE CO. STATE SURCHARGE PLBG (<$500) 0.50
6030 CULLIGAN WAY
MINNETONKA, MN 55345 MAIL-IN FEE 2.00
(952)912-7379 TOTAL 17.50
PAID WITH CC# 0597
OWNER
[II, WINF[ELD STEPHENS
3770 BAYSIDE RD
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
S[ate Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This pennit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The appiicant is responsible for assuring all required inspections are
requested in conformance with[he State Building Code.This permit may be
revoked a[any time for due ca se.
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Applicant Permitee Signature Date Issue y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
05/06/2010 12:10 FAX 9529335049 CULLIGAN MNTKA C�002
FOR,CITY USE ONLY
A, City of Orono '
�''�`�� P.O.Box 66 ' Date Received: . Permit#
��'r �� 2750 Kelley Parkway
�''�`"'r A�roved B � Amount$:
�r ����+����, F Crystal Hay,MN 55323 PP. Y�
����' (952)249-4600 ' �
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CITY OF ORONO—PLUMBING PERMIT
(All Commercial permiu must be approvod by the Building Official or Inspector)
GENERt�L-INFORIVIATION �: � ' ;` ;.'°'::
1. You may apply for plumbing permits by mail or in person at the City offices. Applications will be
reviewed and a pertnit will be issued within two working days.
2. Permit cards will be se��t by return mail after a review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT�BEGIN UNTIL THE
PERNIIT 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 sepazate 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)249-46Q0.
(24-48 hour notice required)
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�Residential ❑ Commercial(Approval Required) �
r ❑New ❑Additional ❑Repairs + �J Replace
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❑ In Accessory Structure?
*You will need prior aaaroval and may need'CUP.(Per Orono City Code,Chapter 78,Article N)
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SiteAddress: ..3��0 0+ S ►�� �D4c�(
Owner: � ��2P�e►r1S Mailing Address:
City: Zip: Jr5.3 � �
Hoine Phone: �5 a•4 0 y ' O�07 Alternate Phone:
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�:Go�tracto''r.?;Tnfor�nat�ori:::'
on: �`��
Contractor: C�ntact Pers °�
c:uL�.����v �v�r�r� coNo�r�o�viNa
Adc�O CULLIGAN �.k State Bond#:
MINNETONKA, MN 55345 �
�. City: (9a2) 933-720Q Zip: Expiration Date:
Phone, Alternate Phone: ; 95a�Q�� -'73 I�
❑ Insurance—Curre�it:
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_ 05/06/2010 12:10 FAX 9529335049 CULLIGAN MNTKA C�003
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FI3CTURE BSMT 1 2" OTHER FIXTURE BSMT 1 2 01'HER
TYPE FL PL TYPE FL FL
Water Closet � Floor Drains
Lavatory Sewer Ejector
Bathroom Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener I
Dishwasher Wet Bar
Sillcocks Miscellaneous
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Yes,this section applies
The replacement of a Residential fixture or appliance that meets all three of the following reqairements:
1. Does no tequire modification to electrical or gas service.
2. Has a total cost of$500.00 or less; excludinQ 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
Maii-In Fee(If Applicable) $ 1.50
Total Permit Fee $
(Permit Fees Continued On Next Page)
2
05/06/2010 12:10.FAX 9529335049 , CULLIGAN MNTKA f�004
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If above does not apply;follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$35.00)
� x.0125 $
(coiitract price) (minimum$35.00)
2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of 5.50) -
x.0005 $
(contract price) (minimum$ .50)
3. P03TAGE&HANDLING(On1y ori 1Vlail-In Applications) $ .—�6' o��Ou
4. TOTAL PERMIT FP1E(Add Lines l,-3 Above)� � '� �S v
• * CONTRACT PRiCE or JQB COST means the actual or estimated dollar amount charged for the
permitted work including matezials, labor,profit;and other fixed costs. It is the amount to be charged
to the cvstomer for the work dona. If any material, equipment, labor oc installations are furnished by
the owner,tenant or any other parly, 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
a�nount of the job cost, the City may request the submission of a signed copy of the actuaI 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. j
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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
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correct. �
Applicant's Signature: _� �� Date: 5 - � • ( �
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