HomeMy WebLinkAbout2004-P07375 - vacuum breaker CITY OF ORONO PERMIT
2750�Kelley Parkway - PO Box 66 Permit Number: Po�3�s
Crystal Bay, Minnesota 55323 Permit Type: vacuumBreaker
(952) 249-4600 Date Issued: 4��i2oo4
SITE ADDRESS: 2677 Casco Point Rd
Wayzata,MN 55391
PID: 20-117-23-23-0020
DESCRIPTION:
Proposed Use: Kesidential
Permit Class: Plumbing
Permit Sub-rype(s): Vacuum Breaker
Permit Type: Vacuum Breaker
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 15.00
Valuation: $ 470.00
State Surcharge Fee: $ 0.50
Misc. Fee: $ 1.50
TOTAL FEE: $ 17.00
APPLICANT: Roto Rooter Services Co. OWNER: Alan& Susan Kluis
14530 27th Ave.N. 2677 Casco Point Rd
Minneapolis,MN 55447 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
--,�,rY�-�Z-c-./� ,���(— ' ��-e!�
APPL[CANT PERMITEE SIGNATURL ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), 1-Applicant, i-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
Sap-04-2003 12:06pm From-CITY OF ORONO +9522494616 T-093 P_002/003 F-7T8
CTTY QF ORONO APPLICATYON FOR PY,UM�3ING PERMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
cENF.RAL INFORMATION
i. You may ap}�ly for plumbing permi[s by mail or in persou ac the City offices.
2. Permit cards will be sent by return mail afrer a review is completed. FERMITS A�tE NOT VALID UNTII.
YOU REC�IV�A P�RMIT. WOR.CC MUST NOT BEGTN UNTIL THE P�RMIT CARD IS POSTET7 ON
THE JOB Sl� ��
3. Plumbing permits may be issued ONLY�o licsnsed plumbin.g coatractors and to properry owners residing
in the dwelling.
4. When any nc:w construction or remodeling is involved, a separate building permit must be obtained.
5. All work must be done in accordance with tiie 5�a[e Code requirements.
6. AII work miuc be inspected and air teszed before it is covered. Call (952) 249-460p. 24-hour notice
required.
Iastrucrion� Complete all icems Qn this applicatio�z. Compute ih�permic fee. Sign and date the
certification. YN'CO'VINL,ETE APPI.TCATIQNS WTLL NOT BE PROCESSED. Tf you have
questions, call (9S2) 249�600.
Flease check one: N�w �_ Addition Repair Replace
�_Residenrial Commercial
.TQB SITE:�?�J—s►�SGb�n*AI'I' �Z oa� Zip: �-�'3�')
O�cvner's Name:_�..� tc i u:�' Telephone i�'umber:_ q�-�t'i I _e�r9
Mailing Address: City: Zip:
Contractor's Name: ft ot e . R•a�a Telephot�e Number: �6 3_�t�i_3 y o y
Mail'uag Address: t u s3 e _ �.�H� ,�v-� N City:„p�ti,v�ov�.:rf Zip: �r���
PL�TMBTNG FZXTURE SC:C-�EDT_TL�
FIXTURE BSMT 15T 2ND OTHER FTXTUR.� BSMT 1ST 2NT� OTFiER
TYPE �'L FL TYPE FL FL
Water Closet Floor Drains
Lavato Sewer E'eczor
Bathnib I.aund Tra
Shower Washer �
Kitchen Sink Water�-Teazer
Dis sal Water Softener
Dishwasher Wet Bar
sillcocks Misc(lisc) Q R � t! C G�iv► fi ft�Ct.en
SeP-04-2003 12:06pm From-CITY OF ORONO +9522494616 T-093 P.003/003 F-778
P�RMIT FEE `AT,CYJLATION(S1
2Q02 State Statute � 'Yes, This Secti�n Appiies
The replaceFnent of a 1Zesidenrial fixture �r appliance that meeCs all three of the following
requirements:
i) Does not require mod.ification to electrical oz� gas service.
2) Has a total cost of$500.00 ar less; excI_ u_ id;na the cosL of the fi��ure or appliance:
anc3
3) Ts Ymproved, instaIled oX replaced by the homeowner or licenced contractar.
Skip next section; Cost of Permit $ 15.d0
Sta.te Surcharge $ .50
Nlail In Fee $ 1.50
If above does not apply, follpw guidelines below:
1. Con�ract Price* is .0125 � of job with a Mi�n2mum Fee of($35.00)
470, � .012; $
(contract pnce) (minimum$35.00)
2. State Surr.harge_ ** Add the State Building Code Division a (Minirnum Fee o�$ .SO)
��j O _ _ x .UU05 $
(concract price) (minimum� .50)
3. ��Sta�e and Handlin� (Only mail-in applicafions) $ 1.50
4. TQTAL PERMIT�"EE (Add Iines 1-3 abo�ve) $
* CONTRACT'PRIC�or]OB COST means[h�actuaI or estimated dollar amount charged for the permitted
work inclnd"uig marcr"sals,labc.,profit,and other fut�d cosu. I�;s the amount to be chara4d to the cust�r�e:
for tho work done. Tf any matenal, equipmene, labor,or ins�allation are furnished by the owner, tenant or
any ather pai�ty the reaso�ble market value of such items mus[bc added to thc estimated GOSt or contract
price for pertnit fee pLupoSes. In the evenc that there is a dispute on the amoux�t of the job cost,the City�1ay
reques[tt�e Stibmission of a signed copy of the actual contract.
** The STATE SURCHARCrB is .0005 of the contract price under$1,o4�,000 or $.50-whichever is greater.
For valuations over$1,000,000 cali [tie Depanment of Inspection Services for the price.
The undersigned her�by applies to the City for issuance af a P�umbing Permit, agrees to do alI
work in strict accardance vvith the ordinances of the City anc! the regulations of the Siate of
Minnesora, and c��rtifies that alI statements made on this application are eomplete, true and
carrecc.
Applicant'sSignat�zre: Ul,(�L,� ����.,�,�c _ Date: o`t�o� o .