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� PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: Posi9i
Crystal Bay, Minnesota 55323 Permit Type: FiXtures
(952) 249-4600 Date Issued: 1 iii6i2oo4
SITE ADDRESS: 3030 Casco Point Rd
Wayzata,MN 55391
PID: 2o-ii�-23-43-oos2
DESCRIPTION:
Proposed Use: itesidential
Pernut Class: Plumbing
Permit Type: Fixtures Permit Sub-rype(s): Multiple Fixtures
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 2,000.00
State Surcharge Fee: $ 1.00
TOTAL FEE: $ 36.00
APPLICANT: Nieman Plumbing&Heating,Inc. OWNER: K Forss& A Ronningen
875 Kunz Dr 3030 Casco Point Rd
Maple Plain,MN 55359 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT RMITEE SIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Apvlicant, 1-Monthlv Reports, 1-Assessing, 1-Finance Page 1
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CITY OF ORONO APPLICATION FOR PLUMBING PERMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City affices.
2. Permit cards will be sent by return 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 the State Code requirements.
6. All work must be inspected and air tested before it is covered. Call (952) 249-4600. 24-hour notice
required.
Instructions Complete all items on this application. Compute the permit fee. Sign and date the
certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have
questions, call (952) 249-4600.
Please check one: New '�' Addition Repair Replace
Residential Commercial
JOB SITE: �G �� ry - / � Zip:
Owner's Name: n L -„ �� Telephone Number: �5��—y 7/ ����
Mailing Address:,3 City� Zip: __
Contractor's Name: ��� ��'�'�rj Telephone Number:7<3-y7y•-zv97
MailingAddress:�,������7`� f`�t— City: /,� ��:.. Zip:S`"'�' "
PLUMBING FIXTURE SCHEDULE
FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 21VD OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavator - Sewer E�ector
Bathtub Laundr Tra
Shower Washer
Kitchen Sink Water Heater
Dis osal Water Softener
Dishwasher Wet Bar
Sillcocks Misc (list)
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PERMIT FEE CALCULATION(S)
2002 State Statute ❑ Yes, This Section Applies
The replacement of a Residential fixture or appliance that meets all three of the following
requirements:
1) Does not require modification to electrical or gas service.
2) Has a total cost of$500.00 or less; excludin� the cost of the fixture or appliance:
and
3) Is improved, installed or replaced by the homeowner or licenced contractor.
Skip next section; Cost of Permit $ 15.00
State Surcharge $ .50
Mail In Fee $ 1.50
If above does not apply, follow guidelines below:
1. Contract Price* is .0125 % of j,ob with a Minimum Fee of ($35.001
�
�ada � �� x .0125 $
(contract price) (minimum $35.00)
2. State Surcharge. ** Add the State Building Code Division a (Minimum Fee of $ .50)
x .0005 $
(contract price) (minimum $ .50)
3. Postage and Handling (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $
* CONTRACT PRICE or JOB COST means the actuai 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 installation are furnished by 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 permit 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 $.50 -whichever is greater.
For valuations over $1,000,000 call the Department of Inspection Services for the price.
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 th t,,all statements made on this application are complete, true and
correct. �
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Applicant's Signature: � Date:���`��/
C ` � � ?� ATE TIME "
CITY OF ORONO CALLED IN � �
INSPECTION NOT �E1 SCHEDULED � �CX,
PERMIT NO. �l/���/ COMPLETED
ADDRESS ���.� C� �'G � �� ���`✓
OWNER CONTR. '�lLL/1'I,b
TELEPHONE NO. ��3 � � ��� �7
� DESCRIPTION ��'���
� 01 FOOTING 11 MECHANIC L RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING Rf 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU: YES_NO
� COMMENTS:
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W WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W �❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑ CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CAIL INSPECTOR
C INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail forthe next in pection 24 hours in advance. �95Z� Z49-4600
OwnerlContrac r si :
Inspector.
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