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Home My WebLink About2014-01369 - plumbing CITY OF ORONO * 2 0 1 4 - Pl 1 3 6 9 * , , 2750 KELLEY PARKWAY DATE ISSUED: 1U25/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1233 BRIAR ST PIN : 10-117-23-24-0030 LEGAL DESC : MAXWELLS ADDN CRYSTAL BAY LAKE : LOT 000 BLOCK 000 PERMIT TYPE : PLUMBING (<$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : FIXTURES- MULTIPLE NOTE: WA"I��:R SOI�'I�I:NI:It APPLICANT PLUMBING FIXTURE FEE(<$500) I5.00 STATE SURCHARGE PLBG (<$500) 5.00 CRO1X CRYSTAL 3440 YOERG DR MAIL-IN FEE 2.00 HUDSON, WI 54016- TOTAL 22.00 (715)386-8667 Payment(s) CHECK 13109 22.00 OWNER FRANK,THOMAS& BARBARA 1233 BRIAR ST WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT �I�he work for which this permit is issued shall be performcd according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not speciYied herein.This permit will expire and become null and void if construction authorized is not commenecd within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conf'ormance with the State Building Code.This permit may be revoked at any time Cor due cause. Gc�c-�e // o2�S / // /.ZV l /SG Applicant Permitee Signaturc Date Iss ed [3v Signature Date - � FOK CITY USE ONLY �j • � city of,Q �� `��C� !� � / , 4 � p.p_��',� Date Received: Permit!!7� / Q � ` 2 7 5 0 Ke l ley Par aj( I ('� �a ''- �' Crystal B�y(�J�I�53a�"'� APProved By: Amount$:�a • �� '�� '`; ' : c',' (952)249`�id Main ��'�'�asxq$�' (952)249-4616-Fa ONO �i�`l��OF ORONO- PLUMBING PERMIT (All Commercial Permits Must be Approved by the State Prior to City Approval) s`�€t r:�';`��r��.��le.er�m�.��4��i��'�.��r1^��i �� 3fa�E��P� �?� ,s�� p � �. t�.�r GENERAL 1NFORMATION 1. You may apply for plumbing permits by mail or in person at the City offices. Applications will be reviewed and a permit will be issued within two working days. 2. Permit cards will be sent by retum mail after a review is completed. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL TI� PERNIIT CARD IS POSTED ON THE JOB STTE. 3. Plumbing pemuts may be issued ONLY to licensed plumbing contractors and to properiy 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 covered. Call(952)249-4600. (24-48 hour notice required) TYPE OF PERMIT Check All That A 1 �Residential ❑Commercial(Approval Required) ❑ New ❑Additional ❑Repairs ❑Replace ❑ In Accessory Structure? *You will need prior approval and may need�`Li1'. (Per Orono City Code,Chapter 78,Article I� Job Site/Owner Information: Site Address: 1� ��_!��1 �C� iZ �� Owner: ��1'1�t�� -��1�� Mailing Address: �� 1 �� ci ��1 L�.�1 L zip: `��,��'l 1 �� Home Phone: ��'l� ��-�� r�l' Alternate Phone: Contractor Information: Contractor. ��1�`1 ��. � � 1. -_��-- Contact Person: ��t ��'� Address: �-�� L� � � � � State Bond#: City: �� L� Zip��./� Expiration Date: Phone: �� '� Alternate Phone: ❑ Insurance—Current: 1 � - PLUNII�ING FIXTURES BEING INSTALLED FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER TYPE FL FL TYPE FL FL Water Closet Floor Drains L avatory Sewer Ej ector Bathtub Laundry Tray Shower Washer Kitchen Sink Water Heater Disposal Water Softener I � Dishwasher Wet Bar Sillcocks Miscellaneous PERMIT FEE CALCULATION(S) BASED OFF - 2002 STATE STATUE � Yes,this section applies The replacement of only one Residential fixture or appliance that meets all three of the following requirements: 1. Does uot require mociification to electrical or gas sere--ice. 2. Has a total cost of$500.00 or less;excludin�the cost of the fi�ure or appliance: and 3. Is unproved,installed or replaced by the homeowner or licensed plumbing contractor. Skip ne�section,if this applies; Cost of Permit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) � $ 2.00.v Total Permit Fee $�`� (Permit Fees Continued On Next Page) 2 PERMIT FEE CALCULATION S -JOBS OVER$500.00 If above does not apply;follow guidelines below: 1. CONTRACT PRICE *is I.25%of contract price with a(Minimum Fee of$50.00) Y.0125 $ (contract price) (minimum$50.00) 2. STATE SURCHARGE �c.0005 $ (aontract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 �3. TOTAL PERNIIT FEE(Add Lines 1-3 Above) $ � * �Oi�iT'P�AC i F2iCE or JOB COST nieans 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, labar or installations are fumished b_y 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 pemut 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. PLUMBING PERMIT APPLICATTON AGREEMENT 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 correct. � ��`�� Date: � � � ( �f� Apphcant s Signature: � �� Reset Form 3