HomeMy WebLinkAbout2005-P08654 - plumbing � � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 P08654
Crystal Bay, Minnesota 55323 Permit Type: FiXn�res
(952) 249-4600 Date Issued: 4i2si2oos
SITE ADDRESS: 754 Boulder Dr
I,ong Lake,MN 55356
PID: 33-118-23-11-0014
DESCRIPTION:
Proposed Use: xesidenhai
Permit Class: Plumbing
Permit Type: Fixtures Permit Sub-type(s): Multiple Fixtures
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: PermitFee: $ 137.50 Valuation: $ 11,000.00
State Surcharge Fee: $ 5.50
TOTAL FEE: $ 143.00
APPLICANT: Plymouth Plumbing&Heating OWNER: Dahlstrom Development LLC
12270 43rd Street NE 7745 Polaris Lane
St. Micheal,MN 55376 Maple Grove,MN 55311
THE UNDERSIGNED HEREBY REQUESI'S 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 PERMITEE SIGNATURE ISSUED BY GNATURE
Copies: 1-File(SiQnitures Requir-ed), 1-Applicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
CITY OF ORONO APPLICATION FOR P�LIMSING PERMIT
Box 66 (2750 Kelley Parkway)
Crystai $ay, li�IN 5�323
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the Ciry offices.
2. Pernut cards will be sent by return mail after a review is compieted. 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 ne�,v construction or remodeling is invo:ved, a separate buildir.g 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 249-4600. 24-hour notice required.
Instructions Complete all items on this application. Compute the permit fee. Si�n and date
the certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have
questions, call 249-4600.
Please check one: / New Addition Repair Replace
/ Residential Commercial
JOB S�: �s� ���u��- ���... ��P:
Owner's i�Tame: ���,� t e.-��...c� Telephone i�umber:
1Vlailing Adda�ess: City: Zip:
Contractor's Name: �/y l �– Telephone Number: 76� g�6/��
1V�ailing Address: /�a o —�,C3 5'� City:Sf l�uZ.1�u�.,.� Zip: SyS 3 � t�
PLUNiBING FIXTLTRE SCHEDUI,E
FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet � a Floor Drains '
Lavator� � 3 Sewer Ejector
Bathtub o� Laundry Tray
Shawer ' � ' `J�asher
Kitchen Sink I Water Heater
Disposal 1 Water Softener
Dishwasher � 1 We� B� � �
SiiICOCnS � a � � � ��iSC �IiStj
���.�I�' rL��+' v'P�.C�JT�`�'��1li
1. 1.2�% of Contract Price* or Mir.ir.:u� Fee ($35.0�)
/�-vC7� x .0125 $
(cont�I price)
2. State Surcharae. ** Add the State Building Code Division
Surcharge to each permit. x .0005 $
(contract price)
or $.50, whichever is greater
3. PostaQe and Handlin� (Only mail-in applications} $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $
� COivT�:�,CT PRICE or JOB CCST mea�.s the ac�ual c:estima[ed dollar ameur.t char�ed 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, Iabor, or installation 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 Ci�y may request the submission of a signed copy of the actual contrac[.
** The STATE SURCHARGE is .0005 of the conzrac� price under $i,000,000 or $.50 - whichever is
greater. For valuations over $1,000,000 cali the Department of Inspectional 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 re�ulations of the State of
Minnesota, and certifies that all statements made on this application are complete, true and
correct.
Applicant's Signature: Date: