HomeMy WebLinkAbout2015-00327 - replace water softener r �
CITY OF ORONO * 2 0 1 5 - 0 0 3 2 7 *
2750 KELLEY PARKWAY DATE ISSUED: 03/19/2015
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 2240 BAYVIEW PL
PIN : 17-117-23-44-0042
LEGAL DESC : WALLACES ADDN TO VIL OF MTKA B
: LOT 039 BLOCK 000
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURE
NOTE: WATER SOFTENER REPLACEMENT
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
STATE SURCHARGE PLBG(<$500) 5.00
CULLIGAN SOFT WATER SERVICE CO. MAIL-IN FEE 2.00
6030 CULLIGAN WAY
MINNETONKA,MN 55345- TOTAL 22.00
(952)912-7379 Payment(s)
CREDIT CARD 8645 22.00
OWNER
ROBERTS,MICHELLE M
2240 BAYVIEW PL
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEME1vT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and thc
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time afrer work has commenced.
The applicant is responsible for usuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
� �- i/�' i�s
Applicant ermitee Signature Date Issu By Signature Date
Oa!19/2015 13:53 FAX fl52�3�5049 CULLIGAN MNTKA �002
R Y bSE ONC.'Y
¢�� CityofQrono /% ���
� Q P.O.Hax b6 Date Receiv d:� /� Pem,it#�
275o Kafiey Parkway
3 �.'� Grysiel Bay,MN 55323 Approved Dy: Amount$: �� �
G�����+�,� (952)249-4600
a�
CTTX QF ORONO--PLUMEING�ERNIIT
(All Commercial permits must be approved by the Building Official o�Ingpqctor}
Cx�NERAL INFORMATTON
1. You may apply for plumbing permits by mail or in person at the City offices_ Applications will be
reviewed and a permit will be issued within two working days.
2, petmit C3rds will be sent by return meil aftcr a review is completed. P�RMITS ARE NOT
V'ALID UNTIL YpU REC�TVE A PERMIT. WORK MLiST Np'x��G1N UNTIL TFIE
p�Rl�'�IT CARD IS PQST�A ON THE JOB STTE.
3_ Plumbing permits may be issued ONLY to lieensed plumbing contractors and to property ovmers
residing in the dwelling.
4. Whcn any new ConstivCtion or remodeling is involved,a separatc building permit must be
obtained.
S. All work must be donc in accordance wiih State Code requirements.
6. All work must be inspected snd air tested before it is covered. CaII(952)249-4600.
(24-4$l�our uotice required)
TYPE OF PERMT7'
Check All That A I
�Residential d Commercial(App�oval Required)
�] New ❑Additional ❑Repairs ❑Replace
/`
❑ Tn Accessory Structure?
*You K�11 need nrior:►pproval and may need�l�P.(Per Ocono City Cocic,Chapter 7B,Article IV)
Jab Site/Owner Information:
Site Address: �.�I O LS Qy v`i e..J P�Gc_Q
Owner: M�k ��a 55'�v�q�0►-1 Mailing Address:
City: Zip: SS 3� (
Home Phone: �a �a - ,3$�{ - � y 1 y Alternate Phone;
Contr3ctor Tnformation:
(7�ltafX,q�3'r�qaV yV � Contact person: ��
60�� CULLI�GAN WAY
Add�6�4fVETp 5tate Bond#:
(952) 93�-72�Op
City: Zip: Expiration Date:
Phone: Alternate Phos�e; �15�- 9�a - 7 31 �
❑ Insurance—Current:
1
Oa.�19/2015 1a:53 FA� 9529335049 CULLIGAN MNTKA �00�
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��. ,f' 1 r�.! r i1l;
FIXTUR� BSMT 1 2 QTHER FIXTUT� BSMT ] 2 O7'HER
TYPE FL FL T�'PE FL FL
Water Closet FIoor Drai�s
Lsvatory 5cwer�jector
Bathtub Laundry Tray
Shower W�her
Kitchen S1nk Water Hcater
rlisposal Water Softener
Dishwashcr Wet Bar
Sillcocks Miscellaneous
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� .�ui� ' c., � ,_ , � r. �. I� �,;'a,, �, , � _ `�� . ,,,,�������,'�'id',r�.y����,�,urn.�:�a, .��,� �:t.,9r
n . i. '
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❑ �Yes,this section applles
The replaccment af a Residential fixture or a liance that meets all three of the following rcquirements:
l. Does not require modification to e)eetrieal or gas service.
2. Has a total cost of$500.00 or less;excludin�the eost of the fixture or appliance:and
3. Is improvec], installed or raplaeed by the homeowner or licensed contraewr.
Skip ncxt sectipn,if this applies; Cost of Permit $_ 15.00
State 5urcharge $�pp
Mail-1n Fee(1f Applicable) $ 2.00
Total�e�r�tit Fee �
(Permft�'eC5 Continued On Next Page)
2
Oa/19/2015 13:54 FAX 952fl3a5049 CIILLIGAN 92NTKA �00�
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ff above does not apply; follow guidelines below:
1. CONTRACT P12]'C�' *is 1.25%of contract pricc with a(Minimutn Fee of$50,�0)
x.0125$
(contruct pricc) (minimum$50.00)
2. STATE SXIRCHARGE �*Add the St2tc BIdg Code Div.Surcharge(Minimum Fee of$5.60)
x.0005 $
(cAntrnct priCC) (minimum S S,OD)
3. POSTAGE&HANDLING(Qnly on Mail-In Applicatians) $ 2.00
4. TOTAY,�°�RMIT FEE(Add N,jnes I-3 Above) $ • ��
■ * CON7'RACT PRICE or JOB C�ST means the actual or estimated doIlar amount charged for tho
petmittcd work including msterials,labor, ptoft, and other fixed costs. tt is the amount to be charged
to the customer for the work done. If any material, equipmen� labor or installativns are fumished by
the owner,tenant or any other pa�ty,the reasonable msrkct value of such itcros must be edd�d to the
�stimated cost or eontract price for permit fee purposes. In the event that t�hcre is a dispute on the
amaunt of the job eost,the Cify may requtst the submission of a signed copy of the actual coniract_
■ *"`The STAT'E SURC�iARGE is.0005 o�ihe eontract price under�I,000,000 or$S.DO—whichever is
greater. For valuations over�1,00O,OOp r,all the Building Department st(952)249�600 for the price.
Ia;K „ i �,�l�vn �p��yy. �^}j��,� I, °r! i i N,"^�' �,�w� I A I.( �ii ) r.
� � p r �s,�-� ',� � .�",�����AP�iL,�,�A��,�1�''A:Cr��]1� "�l �r, '�,t '�h�,,�p�"��.',
���,��P�S��slfa..riL��l.,.a�'4��en.,�aap�II�r.L�. f I t � � �,IL J�:l�A.i ti� ��Z'�
�:
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 al] statements made on this application are complete, true and
correct.
Applicant's Signature: l�ate: 3 - I� - I j
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