HomeMy WebLinkAbout2010-00961 (plumbing) • . CITY OF ORONO PERMIT NO.: 2010-00961
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUEu: 10/07/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 3965 BAYSIDE RD
PIN : OS-117-23-23-0004
LEGAL DESC : AUDITOR'S SUBD.NO. 203
: LOT 057 BLOCK 000
PERMIT TYPE : PLUMBING (<$500)
PROPERTY TYPE : RES[DENTIAL
CONSTRUCTION TYPE : WATER SOFTNER
NOTE: WATER SOFTENER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
CULLIGAN SOFT WATER SERVICE CO. STATE SURCHARGE PLBG (<$500) 5.00
6030 CULLIGAN WAY
MINNETONKA, MN 55345 MAIL-IN FEE 2.00
(952)912-7379 TOTAL 22.00
PAID WITH CC# 0597
OWNER
FELDMANN,GUY
3965 BAYSIDE RD
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this pennit is issued shall be performed according to
Ihe approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing ihis type of work
shall be compied with whe[her or not specified herein.'I'his permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due c use.
��,��.a:c.���� /D/ 7 / l0 �l 7 //D
Applicant Permitee Signature Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
10/07/2010 08:31 FAX 9529335049 CULLIGAN MNTKA 1�002
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FOR CITY USE ONLY
���� City of OronO Date Receivad•�v 7 �D1'erm�t# Olb— ���
� P.O.Box 66
��� Q\i 2750 Kelley Parkway
\���,;�r ��� Crystal Bay,MN 55323 Approved By, Amount$: �a o
y F' o (952)249-4600
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CITY OF ORONO—PLUMBING PERMIT
(All Commercial permits must be approved by the Building OPFicial or Inspector)
GENERA.L INFORMATION
1. You may apply for plumbing permits by mail or in person at the City offices. Applications will'be
reviewed and a permit wiil be issued within two working days.
2. Permit cards witl be sent by retum 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 coveted. Call(952)249-4600.
(2A-48 hour notice required)
TYPE OF PERMIT
Check All That A l
�j Residential ❑Commercial(Approval Required)
/�
�New ❑Additional ❑ Ctepairs ❑ Replace
❑ In Accessory Structure?
*You will need arior auaroval and may need CUP.(Per Orono City Code,Chapter 78,Article IV)
7ob Site/Owner Information:
Site Address: 3565 �a�Sic� Q�
Owner; G4� �e�c�lnnav�v� Mailing Address:
City: Zip:
Home Phone: l�l� -�y� � l$1 S Alternate Phone:
Contractor Information:
Contractor: Contact Person:
CUL�.IGAN VVATER CONDITIONING3tate Bond#:
Address: 6p
MfNNETONKA, MN 55345
C�,; ` �ip:�_ Expiration Date:
Phone: Alternate Phone: `�l5 a-�l►a- 7317
❑ Insurance—Current;
1
10/07/2010 08:32 FAX 9529335049 CULLIGAN MNTKA �003
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; �<:,,�� ';t�;:.tw�;°;s �'L�:i'I�G.�I�U.��,BE�tG-�1�?STAIiLED <.�.
FIXTURE BSMT 1 2 OTHER FIXTURE 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 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 requirements:
I. 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 improved,installed or replaced by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Permit $ ]5.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ Z.00
Total Permit Fee $
(Permit Fees Continued On Next Page)
2
10/07/2010 08:32 FAX 9529335049 CULLIGAN MNTKA 1�004
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If above does not apply;follow guidelines below:
1. CUNTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of 550.00)
x.0125$
(contract price) (minimum$SO.DO)
2. STATE SURCHARGE **Add the State Bldg Code Div, Surcharge(Minimum Fee of 55.00)
x.0005 $
(wntract price) (minimum$ 5.00)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ _ 2.00
4. TOTAL PERMTT FEE(Add Lines 1-3 Above) S ��• �V
� * CONTRACT PRICE or JOB COST means the actua) 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 fumished 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 SURC}3ARGE is.0005 of the contract price under$1,000,000 or$5.00—whichaver is
greater. For valuations over$1,000,000 call the Building Department at(952)249-4600 for the price.
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The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all
work in sVict 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.
A licant's Si nature: � Date: ��- � (�
PP g
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