HomeMy WebLinkAbout2010-00867 - plumbing � � CITY OF ORONO PERMIT NO.: 2010-00867
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUE�: 09/20/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 1635 CONCORDIA ST
PIN : 17-117-23-22-0040
LEGAL DESC : REG. LAND SURVEY NO. ]628
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING (<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURE
NOTE: WATI;R SOFTENGR
APPLICANT pLUMB[NG FIXTURE FEE(<$500) 15.00
CULLIGAN SOFT WATER SERVICE CO. STATE SURCHARGE PLBG (<$500) 5.00
6030 CULLIGAN WAY
MINNETONKA, MN 55345 MAIL-IN FEE 2.00
(952)912-7379 TOTAL 22.00
PAID W[TH CC# 0597
OWNER
ALTON, LISA
1635 CONCORDIA ST
WAYZATA, MN 55391-
AGREEMENT AND SWORIY STATEMEIVT
The work for which this permit is issued shall be performcd according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. "I his permit is for only the work described and does
not grant permission for additional or rclated work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specitied herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of l80 days at any time atter work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due c•use.
�v�'.�c�� 9 �7�� /o �� �3o�/e
Applicant Permitee Signature Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
09/20/2010 12:47 FAX 9529335049 CULLIGAN MNTKA l�002
=� ,
F R ITY tJSE ONLY
�0`� CityofOrono —y�
//�' '� P.O.Box 66 Date Receive . ��Permit# �v`�` ���
����„i,,, �1i 2750KelleyParkway
� �� ? r� Crystal Bay,MN 55323 Approved By: Amounl$: ��r D
���k�'.�I�os� (952)249-4600
���.a��'�
CITY OF ORONO—PLUMBING PERMIT
(All Commerciel permits musc be approved by the Building O�cial or Inspector)
GENERAL INFORMATION
l. You may apply for plumbing pertnits by mail or in person at the City offices. Applications will be
reviewed and a permit will be issued within two working days.
2. Permit cards will be sent by return mail af�er 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 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 A 1
�Residential ❑Commercial(Approvai Required)
�New ❑Additional ❑Repairs ❑Replace
❑ In Accessory Structure?
*You will need arior anaroval and may need CUP.(Per Orono City Code,Chapter 78,Article 1V)
Job Site/Owner Information:
Site Address: �b 3 S l.u ht o r���a s�'
Owner: �i 5 0 ��� �►1 Mailing Address:
c;�y: z�p; Ss 3 91
Home Phone: 95 a -y� ( - gU�SO Alternate Phone:
Contractor Information:
Contra�tcU��� . . ' I I IlUivs-IQ�act Person: � �a��9
6030 CULLIGAN WAY
Address: M 5�r State Bond #:
�
�952) 933-7200
City: Zip: Expiration Date:
Phone: Alternate Phone: 9sa - 9ia -�3 I�
❑ Insurance—Current:
1
09/20/2010 12:47 FAX 9529335049 CULLIGAN MNTKA C�003
._ ►
,.:.;,,.,:� �� � �� ��;�.���������rr��rr�T�.i�, �
�.
FiXTURE BSMT 1 2 OTHER F1XT�JRE BSMT 1 2 OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous
�� �`t`,�'Ca�`.� ��3���a`ei�i 4 r 1td+���k`3��'���`it1V����li� L� l.��l,��A��-(i'���e�_i�yt�Ce�"�.�#,�a i 'ry�y;3! �'trl�t.'��� c��
� v t �rt t C +5 i� r zC��..
et�� �r�"�`A�-f e�����tiiy mr+ �t � y, r5i-v.�4 �,, � ��d ,� }i r..��
��,,,��,�s����;.�,�'� " " ?'�,� C,�����:t�SED.O��-2�b2,ST��''�STAfiL+, +;, �� r,� , r n�� _� � �
k i x,� e E� I i.� .ai th .9. �C.r.r-
� Yes,this section applies
The replacement of a Residential fixture or appliance that meets all three of the following requirements:
l. Does not reqpire 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 licensed contractor.
Skip next section,if this applies; Cost of Permit $ I 5.00
State Surchazge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee � a��bU
(Permit Fees Continued On Next Page)
2
09/20/2010 12:47 FAX 9529335049 CULLIGAN MNTKA �004
, „_.,rf...., _�N �( -�,y.�{�y�
����� ,i�;;i.� �'` ; '`� ,:+��,_ �,n' ��tt.� �ti c_ �,�7�� (� 'ii�C;1;,i;
`'r.;��-.ai.� �e'a :f�'i �'.�11�� .����:�7��1�G':N�P11tf. ���1'�:V,l'Y�'. _ �
, -..+.;,
,.; � r���•,_
.,-
;�.;;...:��.� �.�
:.','s
:a`.`��
.. .. . _
�
t;.�
:�:r ?.� _ Y,., y:j,`.,, �'t.v c
If above does not apply;follow guidelines below:
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of 550.00)
x.0125$
(contract price) (minimum 550.00)
2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee ofS5.00)
x.0005 $
(contract price) (minimum$ 5.00)
3. POSTAGE&HANDLTNG(Only on Mail-ln Applications) $ 2.D0
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S o�. 0�
■ * CONTRACT PWCE or JOB COST means the actual 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. [f any material, equipment, labor or installations are fumished 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 SUItCHARGE is.0005 of the contract price under$1,000,000 or$5.00—whichever is
greater. For valuations over$1,000,000 call the Building Department at(952)249-4600 for the price.
i�` � � 7 t � :t. �:.31f-C�JJ..31�"iL�1V;14 t 4'�y';tf � '�d 'CIA!'F^i,F
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 certifes that all statements made on this application are complete, true and
correct.
ApplicanYs Signature: �� Date: 9 - ao - �U
r .���
R�set �si'r �
._ �.��.r�^l�ititi
3