HomeMy WebLinkAbout2014-01348 (plumbing- water softener) • CITY OF ORONO * 2 0 1 4 — PJ 1 3 4 S *
2750 KELLEY PARKWAY pATE �ssLE��: 1U19/2014
• ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3225 CASCO CIR
PIN : 20-117-23-43-0021
LEGAL DESC : SPRING PARK
: LOT 029 BLOCK 000
PERMIT TYPE : PLUMBING (<�500)
PROPERTY TYPE : RESIDENTIAL
COIYSTRUCTION TYPE : WATER SOFTNER
APPLICANT PLUMBING FIXTURE FEE (<��500) I5.00
STATE SURCHARGE PLBG (<�500) 5.00
CULLIGAN SOFT WATER SERVICE CO. MAIL-tN FEE 2.00
6030 CULLIGAN WAY
MINNETONKA, MN 55�45 TOTAL 22.00
(952)912-7379 Payment(s)
CREDIT CARD 8645 22.00
OWNER
LEESTMA, MARTIN & KATHRYN
3225 CASCO CIR
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
l�hc�vork for�chich this permit is issucd shall he performcd according�o
thc approved plans and specifications,applicable Citv approcals.and the
State Buildin�Code. �I�his permit is for only�the work described and does
not orant permission tor additional or related work which requires separate
permits. All provisions of la�cs and ordinances�o��erning this t��pc��f work
shall be con�pied�vith N�hether or not speciticd herein.l�hi>permit���ill
e�pire and become null and void if construction authorized is not
commenced within 180 dars ot�the date ot�issuance,or if construction is
suspended for a period of 180 da��s at am�time after work has commenced.
The applicant is responsible for assurin�all required inspections are
rcquested in conformance with the State f3uildinc Code.This permit ma��hc
revoked at any tinre for due cause.
�/�
, �,��, •t�c.- f f �. / V �C_l 17 �� / ��/ ��1
Applicant Permitee Si na urc Date Issued [���Signaturc Date
11/18/2014 14:02 FAX �529�a5049 CULLIGAN MNTKA �002
� FOR CITY t75E ONLY
City otOrono
O���� P.O.Eox 66 Aau Received; Permit p
�.yr., 2750 Kelley Parkwey
��tf�y:'� Crysts]Hay.MR 55323 Approved By Amount S:
,���� (952)149-4600
CITY OF ORONO-�LU11'IBING pERNIIT
(All Commercial permirs mus�be approved by ehe Building Off?cinl or Inspec�or)
GEI•TERAL INTQR�IATION
1. You may apply for plumbing permits by mail ar in person at the City offices. Applications wiil be
reviewed and a permit will be issucd within two working days.
2. Permit cards will be sent by rcturn mail after a review is completed. PERMITS ARE NdT
VALID UNTI7..YOU RECEIVE A PERMIT. WORK MUST NOT BEG1N i3N�'XX.THE
PER'VII7"CARD IS POSTEA ON TFIE JOB SZ1'�.
3. Plumbing permiSs may be issued ONLY to licensed plumbing contraetors ar+d to property owners
residing in the dwelling_
4. When any new construction oi�emodeling is invo)ved,a separate building permit must be
obtained.
5. AI!work must be done in accordsrite with State Code requirements. �
6. All work must be inspected and air tested before it is covered. Call(952}249-4600.
(Z4-4B hour notice requirCd)
��a��Ex�T
Gheck All That A. I
�Rcsidentia! ❑Commercial(Approval Required)
��1ew 0 Additional ❑Repairs ❑Replace
❑ In Accessory 5trueture?
*'You will need vrior approval and may need CUP.(Per Orono City Code,Chapter 78,Article IV)
3ob Site/Owner Tn£orn�ation:
Site Address, �� � � C�'-� l= -
Uwner: � �lr-. Mailing Address:
City; Z�P�
Home Phone; __ Alternate Phone: 9S�� �a0_ "�L�
Con�ractor Information:
Contractor: Contact Person: ��
CULl.�GA,4� 1I1�ATE9� CC314�ITdOfV1dVG
Address:603t� •� , 5tate Bond#:
Mlh"fVETONKA, �1Jii� 5�345
�,�ity: (95�1 9;�;�^7�rin lp: �xpiration Date;
Phone: Alternate Phone: �Jra- � E aZ-��7
❑ Insurance-Current:
1
11/18/2014 14:02 FAX 95293a5049 CULLIGAN MNTKA f�003
,.�r,�.� .�,d,:;r.,qu..��0,-" �, ,����:.,d,,,�,�;� � . .I ' +, ^`+1irS' ;i,�rC�;1 '��I;�,),'," ';,!
�"�' ^� t���,�' �,`��r:,'.�°��,x�,,a�p�L �'r�,��� �° ,�:��� �;�B�T�TC7��S�I',A���'��`' � .�� ����:,,,. ,� 'r��',
,�
FI?CTURE BSMT 1 2 OTH�R FIXTURE BSMT 1 2 OT[-I�li
TYPE FL FL T�Y'PE FL FL
Watcr Closet Floor Drains
LavaSory Sewer Ejector
Bathtub Laundry Tray
5hower �'�'��
Kitthen Sink Water Heater
Disposal Water Sof�ener I
!
Dishwasher Wet Bar �
Sillcocks Miscellaneous
� i .,i....w�yie�i��vac',�lwi., „�^.;� •.i��y� _' '_•J' '�9 '.t',�',d��"i"�$'n'{;Ilk��iY.,'�pl�:F"i����7'���r�P10�f7,;I;r���Gj^tl„'1•�5.�i.w.�
�(,;�.;J,u.��,?:rj1,�.i`.fl:;.,�.,,,,,�'iri. , •„�: ?!'h��.r,�'��`a,a�� h '�� i�. , i .� ,, ,
,��l�..,,�, „ ,���..:�q.,u,,.(��.,. �IEl��'�,�.�E,GAL ���1TT�'l�i��.S����•>„,;,:��a .;,,;,;�,,�,7�,�:�; -,.�,,,_ ..;c,.,;?�;
:A��,�_. .�.,�'.�.}�Ur°''ti.�,°�;"��dn!t�,�ll„ �,��. �.o,.,i�. p,i,,�. ,r,,�, ���,��r �rd�,rq%' "j'..f��,n li�.'P ,er'�"�.I��'�P.'il
',wP�P���.ali:iiA�,�t:f�'i.i �hhg��y.�a�,�.t1R�.�f��l�r. q��r,}Il{ 'ua� '"j,; ��j�.,, .'r,i,; ,'iiJl�;�t,i�1!;�'�,��i ,G�7,t:;:�,�,������
r
yw'
,�.,;:,�.�,>.",�,T.�.«�, H , .,,,,.,.��.u..M�,.,, ��3E'D;,�FF '����'��,SZ'�fiES�',� i,�a� � � „��:,.,� ;, ,�,� V ,c,.,..
❑ Yes,this section applies
The replaccment of a E�esldential fixture or sppliance that meets a1l three of the following requirements:
1. Does not require modi�tCstion to electrical or gas Service.
2. Has a totaI cost of$500.00 or less;excludin the cost of the fixturc or appliance:and
3_ Is improvcd, installed or replaced by the homeowner or licensed eontractor.
Skip next section,if this spplies; Cost of Permit $ I 5.0�
StAte Surcharge $ 5.00
Mail-In Fte(If Applicable) $ 2.OQ
Total Permit Feo $
(Permit Fees Continued On ivext Page)
2
11/18/2014 14:02 FAX 95299�5049 CULLIGAN MNTKA �004
l'Hr�r 1�" I '. 17 n�. ,�.,..n. .1,. .,.�.., .,.;tyJ.�.�., �, �. .a yu ��,J('iCr." f.`i�'�,"
'`�� `��s,',��'� ,;,;;. „�ry '';�? � �' E. �n,��� � ,,� ; �TI,�01*]'� �O �t�,.,�,' R"��`50.��; ,.�,,�.;,��� �, �;.,���:
i,���'� ,.o;r���, �,��. .�����t ��11,;� �. �1,�� �,,; .;� �$,�:'�. � "' ;,'�' 4 �i „r,,l�:;,:,:.,.
If above does not apply;follow guidelines below:
1. CONTYtAC7'PXZiCE *is]25%of contract price with a(Minimum Fee of$50.00)
x.�125�
(contrnct pricc) (minimum$56.00)
2. STATE SURCHARGE �*Add thc Statc Bldg Code Div. Surcharge(A�Iinimum�ee of�5.00)
x.0045 $ �
(conaae[price) (mioimum S 5,00)
3. POSTAGE&HANDLING(�nly on Mail-In Applications) $ 2.OQ_
4. TOTAL PERMIT FEE(Add Lines 1-3 ABove) � �e, (�l�
■ '� CONTRACT PRTCE or JO$ COST means the actual pr estimated dollar amount charged for the
permitted work inc)uding maferials, labor,profit,and oth¢r fixed costs. It is the amount to be charged
to thc customcr for thc work don�. If any material, equipment, labor or instAlIations are fvmished by
thc orvner,tenant or any other parry,the reasonable market value of such items must be added to the
es[imated cost or contraet price for permit fee purposes, In the event diat there is a dispute on the
3mount of the jpb cos� the City may request the submission of a signed copy of the actual contract.
■ �'�Thc STATE SURCHARGE is .000� of the canuact price under$],000,004 or$5.00—whichever is
greater. For valuations over$1,000,000 call the Building 17epartment at(952)?49-4600 for the price.
k'a;a 1 �1 i. :W ! �'Lf,t7rky��r�t� 1 y� �y�� �il' i' a.� 1 �{r ' � ry+ q''�u��v4'�y d��
i'yI�'1p �y^,� %.'{,1 4 a� �.r 9 �{:y�� , �:� 7y7'!��7',� !i''A'r`I� 1 �.� led� '(�t;^,v�
���ia1�M1v�F!`�P�M�iV cl�.:ui�4�4a�i1��.��Y�w1ar•+1'��lJ� ' I�tu� M '�I'.', 1 � r f�. il� �' R"r.7'J 4•il,���.1,r�'�.��j,�r!I`.r;��i(•�dR�!F;�.'� �.)�
The undersigned hereby applies to the City for issuance of a Plumbing 1'ermit, agrees to do all
wark in strict accordance with the ordinances of the City and the regulations af the State of
Minnesota, and certifies that all statements made on this �pplication are complete, true and
correct.
Applicant's Signature: Aat�: ��- 1� -��
1Ftir'S L��r�y,�=y�'�;�,,:�1���N"t]!��r�(�:;��lf�
��.R�es�t,';F�o'r,>m��,
�� "-�u�.;.�,r�„�,��„�,�.iv�,:u��.,r;�„��`I
3