HomeMy WebLinkAbout2012-00730 - plumbing CITY OF ORONO * z 0 1 z - 0 0 7 3 0 *
� � ' 2750 KELLEY PARKWAY DATE ISSUED: 07/3U2012
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3980 CHERRY AVE
PIIY : 08-117-23-33-0026
LEGAL DESC : CRYSTAL BAY V[EW
: LOT 000 BLOCK 005
PERMIT TYPE : PLUMBING (<$500)
PROPERTY TYPE : RES[DENTIAL
CONSTRUCTION TYPE : FIXTURE
NOTG: WILKINS VACUUM BREAKER INSTALLATION ONLY.
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
SCHULTZ, KEVIN
3980 CHERRY AVENUE STATE SURCHARGE PLBG (<$500) 5.00
MOLJND,MN 55364- TOTAL 20.00
OWNER
SCHULTZ, KEVIN
3980 CHERRY AVENUE
MOUND, MN 55364-
AGREEMENT AND SWORN STATEMENT
"fhe work ti�r which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separatc
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specitied herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at e fo ue se.
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Applican ermitee �gnature Date Issue y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
/
, FOR CITY[JSE ONLY
' ,��� City of Orono
O' Q P.O.Box 66 Date Received: Permit#
�;,,,,,� 2750 Kelley Parkway
a ;���'R;��.`�' ti Crystai Bay,MN 55323 Approved By: Amount$:
����:�+�,y.�o` (952)249-4600—Main
asao$ (952)249-4616—Faa
CITY OF ORONO - PLUMBING PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
htt�://wwr�.dli.mn.«ov/CCLD/I'DF/ e l�imb tanreva �. df
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City offices. Applications will be
reviewed and a pernut 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 pemuts 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 pemut 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 Ap ly) �
�.Residential ❑ Conunercial(Approval Required)
(�New ❑Additional ❑ Repairs ❑Replace
❑ In Accessory Structure?
*You will need prior approval and may need CUP. (Per Orono City Code,Chapter 78,Article IV)
Job Site/ Owner Information:
Site Address: ��� � � .��
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Owner: I�`�Il1J �j�--.� Mailing Address: c�A(YL�
City: C3�Ot1D Zip: �5 3lsz�Q
Home Phone: �Qt Z-"11'� -�ls�l� Alternate Phone:
Contractor Information: �,
�
Contractor: CT;�I�)�-`�- Contact Person: ��,AM� �
Address: State Bond#:
City: Zip: Expiration Date:
Phone: Alternate Phone:
❑ Insurance—Current:
1
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_� � ���,� � � � � PLUMBING�FIXTURES BEIl�_y ���TALLED � "����'� ������� ,
FIXTURE BSMT 1' 2 OTHER FIhTL)RE BSMT 1 2' OTHER '
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower W asher
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous
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� PERMIT FEE CALCULATION(S) �
� BASED OFF - 20U2 STATE STATL7E �
❑ Yes,this section applies
The replacement of only one 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; excludinQ the cost of the fixture or appliance: and
3. Is improved, installed or replaced by the homeowner or licensed plumbing contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ ��
Total Permit Fee $ �.�
(Permit Fees Continued On Next Page)
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�+ �,� ' � PERMIT FEE CALCULA'I�,�R ��.�(.)B� �� �
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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 $
(contractprice) (minimum$50.00)
2. STATE SURCHARGE
x.0005 $
(contract pnce)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
pernutted 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 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.
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,1 !»' }�ry.# �;�
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.
Applicant's Signa � v Date: �—��r��
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