HomeMy WebLinkAbout2005-P08620 PERMIT
�ITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Num er: Pos62o
Crystal Bay, Minnesota 55323 Permit Type FiX�ures
(952) 249-4600 Date Issued: 4ilgi2oos
SITE ADDRESS: 4135 Bayside Rd
MAPLE PLAIN,MN 55359
PID: 06-117-23-14-0025
DESCRIPTION:
Proposed Use: Kesidential
Pernut Class: Plumbing
Permit Type: Fixtures ermit Sub-type(s): Water Heater
DETAILS:
Approved per resolution#:
Separate permits required: I
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 15.0o Valuation• $ 0.00
State Surcharge Fee: $ 0.50
Misc. Fee: $ 1.50
TOTAL FEE: $ 17.00
APPLICANT: Norblom Plumbing Co. OWNE ; CHARLES N&HELEN F HAYSSEN
2905 Garfield Avenue S. 4135 BAYSIDE RD
Minneapolis,MN 55408 MAPLE PLAIN MN 55359
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE RE L IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CI OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
%��C�.c� Lr� B�'K.aI�K
APPLICANT PERMITEE SIGNATURE SUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reports, 1-Assessine, -Finance Page 1
� � �� .
CITY OF.ORONO. APP ICATION FOR PLUIVIBING PERMIT
� Box 66 (2750 Kelley Parkway) - � ,
Crystal Bay, MN 55323 . , - �
CENERA,L INFORMATION .. . � : . . :. .
1. You may apply for plumbing permits by mail or in pers n at the Ciry offices. ` �
2. Permit cards will be sent by return mail after a review is ompleted. PERMITS ARE NOT VALID UNTIL
YOU RECEIVE A PERMIT. W U T BE IN NTIL THE PE T D D O
THE JOB SITE.
3. Plumbing permits may be issued ONLY to licensed plu bing contractors and to propeny owners residing
in the dwelling.
4. When any new construction or remodeling is involved, separate building permit must be obtained.
5. All work must be done in accordance with the State Co e requirements.
6. All work must be inspected and air tested before it i covered. Call (952) 249-4600. 24-hour notice
required.
Instructions Complete all items on this application. ompute the permit fee. Sign and date the
certification. INCOMPLETE APPLICATIONS WI L NOT BE PROCESSED. If you have
questions, call (952) 249-4600,
Please check one: New Add tion Repair _ Keplace
' _�/'ftesidential Co ercial
, ., _ . .. ... __
HAYSSEN, CHARLES/HELEN " _
. _ ... ..
`TA��I��- 4135 BAYSIDE ROAD , t
„ .
� O'wiier's�NameS. ORONO, MN 55359 ,, . �_ Zlp. ` -,..._...
" (952)475-3096 �� �'��ephone Number
Muiling Ai�c�ress:�� � C1:tY� ' :�Zip; , -
, .__..
. Contractor's lyame: � .
� TelephoneNumber:., (��2��z�-yo�3
Mailing Address: ZqD,S Q
-So: CYty:_/�'JfplS Zip: SS���
BIN I D E
FIXTURE BSMT 1ST I 2ND OTHER FIX URE BSMT 1ST 2ND OTHER
TYPE FL FL TYP FL FL
Water Closet Floo Drains
Lavato Sew E'ector
Bathtub Laun Tra
r Shower Was r
Kitchen Sink - Wate Heater
Dis osal . . _ . _... _
. .. . ._..._
Wate Softenei .
, . _ ...., . . .
,.. . .._ _
Dishw�sher .: . _.. _. .. _..
E , . .. Wet ar .. ' ;. ' .
Sillcocks � Misc list
;
�FI�MIT FEE CALCULATION(S?.
2002 State Statute � Yes, This Section A lies
The replacement of a Residential fixture or a ia ce that meets all three of the following
requirements:
1) Does not require modification to elect ical or gas service.
2) Has a total cost of$500.00 or less; ex ludin the cost of the fixture or appliance:
and
3) Is improved, installed or replaced by t e homeowner or licenced contractor.
Skip next section; Cost of Permit $ 15.00
State Surcharge $ .SQ
Mail In Fee $ 1.50
If above does not apply, follow guidelines below:
1. � Contract Price* is .0125 % of job with a M nimum F of 35.00
x .0125 $
(contract price (minimum$35.00)
2. State Surcharge. ** Add the State Building ode Division a (Minimum Fee of$ .50)
x .0005 $
(contract pric ) (minimum $ .50)
3. Posta�e and Handling (Only mail-in appli ations) $ 1.50
F �� c�o
4. TOTAL PERMIT FEE (Add lines 1-3 ab .ve) $ —
* CONTRACT PRICE or JOB COST means the actual r estimated dollar amount charged for the permitted
work including materials,labor,profit, and other fized 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 it ms 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 ontract.
** The STATE SURCHARGE is .0005 of the contract pr ce under$1,000,000 or $.50- whichever is greater.
For valuations over $1,000,000 call the Department o Inspection Services for the price:
The undersigned hereby applies to the City for issu nce of a Plumbing Pernut, agrees to do all
work in strict accordance with the ordinances of t e City and the regulations of the State of
Minnesota, and certifies that all statements made n this application are complete; true and
correct.
A licant's Signature• Date: � '� I b5
PP