HomeMy WebLinkAbout2011-01567 - water softner CITY OF ORONO PERMIT NO.: 2011-015G7
, 2750 KELLEY PARKWAY
, ORONO, MN 55356- DATE rsSUED: 12/19/2011
(952) 249-4600 FAX: (9�2) 249-4616
ADDRESS : ll05 BROWN RD S
PIN : 10-117-23-24-0004
LEGAL DESC : UNPLATTED 10 ]17 23
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING (<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTIOIV TYPE : WATER SOFTNER
I
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
CULLIGAN SOFT WATER SERVICE CO. STATE SURCHARGE PLBG (<$500) 5.00
6030 CULLIGAN WAY
MINNETONKA, MN 55345 MATL-IN FEE 2.00
(952)912-7379 MISC FEE 0.00
TOTAL 22.00
PAID WITH CC# 0597
OWNER
CHRISTENSON, JERRY
1 105 BROWN RD S
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
� The work for wi�aci�this permit is issued shall be performed according to
i the approved plans and specificanons,applicable City approvais,and [he
State Building Code. This pennit is for only the work descrfbed and does
not grant permission for additional or rela[ed 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 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 I
suspended for a period of 180 days at any time after work has commenced. �
The applicant is responsible for assuring all reyuued inspections are
requested in conformance with the Sta[e Building Code.This permit may be
revoked at any time for due cause�
�l��.�-�- (�- � � , �
� Applicant Yermitee Signature Date Issued By ign re ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER TH N DESCR]BED AB E.
12/19/2011 14:13 FAX 9529335049 CULLIGAN MNTKA [�002
, FOR CT!'Y l7SE ONLY
a4p�O CityotOrono
` P.O.Box 66 Data Received: Permit#
/ h� 2750 Kelley Parkwey
�� q����+�' � Crystal Bay,MN 55323 Approved By, Amount S:.
���o (952)249-4600
CITY OF ORONO—PLUMBING PERMIT
"' (AU Commercial permits mus[6e approved by the Building pfficial or InspecWr)
GENER.AL INFORMATION
1. You may apply for plumbing permit�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 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 covered. Call(952)249-4600.
(24-48 hour aotice required)
TYPE OF PERMIT
Check All That A 1 � �
�Residential ❑Commercial(Approval Required)
IZYNew ❑Additional ❑Repairs ❑Replace
„ �
❑ In Accessory Structure7
*You will need arior aanroval and may need CUP.(Per Orono City Code,Chapter 78,Article 1V)
Job Site/Owner Information:
Site Address: �� QS 6 r0 w�1 1�� s
Owner: i�p�Y �ri�'ian3 0� Mailing Address:
c��y: z�P: Ss39 i
Home Phone: b(a - ���� 3�7 a Alternate Phone:
Contractor Information:
CULL9��IV�1'IAT Contact Person: _ _
���03U CULL.IGAN IR►AY State Bond #:
TON ,
�- City: �952) 933-l200 Zip: Expiratior�Date:
'' Phone: Alternate Phone: �15a - 9� a - �317
. ❑ Insurance—Currertt:
1
12/19/2011 14:14 FAX 9529335049 CULLIGAN MNTKA f�003
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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 �
Dishwasher Wet Bar
Sillcocks Miscellaneous
' ''�'��'F�J�d.� ���, �^'Aw����7 t'���� : . .. �'�'L"�t:l�ti��.�-. .;1� 4���5 �'TM.�' "`�,�t'�"Y"� `� '`'J,�'' ' 'f� �
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� Yes,this section applies
The replacement of a Residential fixture or�lianca that meets all three of the following requirements:
l. Does not require modification to electrical or gas service. •
2. Has a total.cost of$500.00 or less;exclu ' the cost of the fixture or appliance:and
3. Is improved,installed or replaced by the homeovmer or licensed contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surchazge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee S
(Permit Fees Continued On Next Page)
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12/19/2011 14:14 FAX 9529335049 CULLIGAN MNTKA C�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�50.00)
' x.0125$
(contract price) (minimum 550.00)
2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee oiS5.00)
x.�005 S
(contracrprice) (minimumS 5.00)
3. P05TAGE&HANDLING(Only on Mail-In Applications) a 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S ��•�v
■ * CONTRACT PRICE or JOB COST means 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, labor or installations aze fumished by
the owner, tenant or any other parry, the reasonable market value of such items must be added to the
estimated cost or contract price for peRnit 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 SURCHARGE is.0005 of the contract price under$1,000,000 or$5.00—whichever is
greater. For valuations over$1,000,000 call the Bui(ding Department at(952)249-4600 for the price.
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The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all
work in strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all statements made on this application are compfete, true and
correct.
Applicant's Signature: Date: I� — IcI ' (�
'���'�$f�l ,
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