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CITY OF ORONO PERMIT TYPE:
�2750 Kelley Parkway- P.O. Box 66 Permit Number: -.:?;`f`��T��;
Crystal Bay, Minnesota 55323 � -
(612)473-7357 Date Issued: `_`� � - _�-�` _
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SITE ADDRESS:
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REMARKS:
FEE SUMMARY: '
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CONTRACTOR: _. ���,�-:� ;:;�,-;r. __ WNER:
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APPLICANLPERMITEE SIGNATURE I ISSUED BY:SIGNATURE
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CITY OF ORONO �P LICATION FOR PLUMBING PERMIT
Box 66 (2750 Kelley Parkway) 'i
Crystal Bay, MN 55323 ii
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in p son at the City offices.
�. 2. Permit cards will be sent by return mail after a revi w is completed. PERMITS ARE NOT VALID
UNTIL YOU RECEIVE A PERM�IT. WORK US NOT BEGIN UNTIL THE PERMIT CARD IS
POSTED ON THE JOB SITE.
3. Plumbing permits may be issued ONLY to licensed plu bing contractors and to property owners residing
in the dwelling.
4. When any new construction or remodeling is involve , a separate building permit must be obtained.
5. All work must be done in accordance with the State ode requirements.
6. All work must be inspected and air tested before it is vered. Call 473-7357. 24-hour notice required.
Instructions Complete all items on this application. Compute the permit fee. Sign and date
the certification. INCOMPLETE APPLICATIONS LL NOT BE PROCESSED. If you have
questions, call 473-7357.
Please check one: �_ New Additio Repair Replace
�_ Residential ' ommercial
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JOB STTE: �3� �c�le c�.� Zip:
� Owner's Name• P,- Telephone Number: �I�:. q�c/ - OUo y
Mailing Address: ��e r- � � I City: 1�� � Zip: SS3 y�i
Contractor'sName:La,ke ; �l ; � -(e�,(��.� TelephoneNumber: G,�i/ir4�!-��v�
MailingAddress: lay� �ti� y+ City: S�u�y��nn�Zip:�r• ,�s���
PLUMBING �'IXTURE SCHEDULE
FIXTURE BSMT 1ST 2ND OTHER F TURE BSMT 1ST 2ND OTHER
TYPE FL FL T PE FL FL
�%ater Cioset I �P=�er Ejector
Lavatory f � dry Tray
Bathtub � W her
Shower W ter Heater i
Kitchen Sink � ' W ter Softener
Disposal i W t Bar
�''"�11� Fl or Drains
Dishwasher I
Sillcocks
3 M sc clist> ` 5��.p
���M k� , t 5r,,E+�.c��
1` P�p�w� oa�
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a,,��e�-5 0. Num;�.I:nc� .
y.,u,ee.�.F�l!� Qp�-los� Le��
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PERMIT FEE CALCULATION
1. 1.25% of Contract Price* or Minimum Fee 5.00
�`l, 5CQ�f`'= x 1.25 $ ���ca�
(contract price)
` 2. State Surchar�e. ** Add the State Building Co e Division
' Surcharge to each permit. /y��v U`�' x .0005 $ � 2�
(contract price)
3. Posta$e and Handlin� (Only mail-in applicati ns) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 abov ) $ �9� �s3
* CONTRACT PRICE or JOB COST means the actual or es imated dollar amount charged for the permitted
work including materials, labor, pro£it, and other fixed costs. It is the amount to be charged to the
customer for the work done. If any material, equipment, bor, or installation are furnished by the owner,
t:.naat cr a:.y other p^�� 1ze reasonabl� �a:�et .�a:ue of uch items rnus: be a�ded to the es:imated c�st
er centract pricP f�:per±�it fee gurposes. In the event tha there is a d:spute cn t�e aazount of the job cost,
;' the City may request the submission of a signed copy of the aetual contract.
� ** The STATE SURCHARGE is .0005 of the contract p e under $1,000,000 or $.50 - whichever is
greater. For valuations over $1,000,000 call the Depart ent of Inspectional Services for the price.
The undersigned hereby applies to the City for issuanc of a Plumbing Permit, agrees to do all
wark in strict accordance with the ordinances of the ity and the regulations of the State of
Minnesota, and certifies that all statements made on is application are complete, true and
correct.
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Applicant's Signature: Date: ����3 -��
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�ATE TIME
CITY OF ORONO CALLED W ��' ��
INSPECTION NOTICE SCHEDULED =s- ' � `'" l�' ' �'�
PERMIT N0. �/-'.�-� �� conn TEo ��
ADDRESS �� � � �
OWNER CONTR.
TELEPHONE N0. � �`�`" - 7 Cc0 -
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 1$ EXC V/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 1� LAK SHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 341 TRE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17I SITE NSPECTION
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Q 05 FINAL 14 SEWER HOOK-UP 06,PR0 ESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 'COM LAINT
J 07 DEM - AL 15 SEPTIC INSTALL. 22 FOLL W-UP
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09 PLUMBING RI 23 SEPTIC FINAL 35 IiARD OVER REMOVAL
� 10 PLUMBING FINAL 36 �OUN TION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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� WORK SATISFACTORY:PROCEED C PROJECT COMP�ETE
W ❑CORRECT WORK&PROCEED I� ISSUE CERTIFICATE O OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMP(�RAR
� BEFORECOVERWG
PERMANEN
CJ CORRECT UNSAFE CONDITION WITHIN HOURS. L_' PHOTO TAKEN I
INSPECTOR WILL RETURN
C CITATION ISSUED,
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the n�xt inspection 24 hours in advance.473-�3�J
Owner/Contrap�or o� �it :
k=_
Inspector. -�---� `
While Copyllnspector's File `, Canary CopylSite Notice