HomeMy WebLinkAbout2003-P06452 - plumbing PERMIT
CITY ��� �RONO
2750 Kelley Parkway- PO Box 66 Permit Number: Po6asz
Crystal Bay, Minnesota 55323 Permit Type: FiX�ures
(952) 249-4600 Date Issued: 6�23�2003
SITE ADDRESS: 1725 Concordia St
Wayzata,MN 55391
PID: 17-117-23-22-0044
DESCRIPTION:
Proposed Use: Kesidential
Pernut Class: Plumbing
Pernut Type: Fixtures Pernut Sub-type(s): Plumbing Undefined
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
RPZ for irrigation
FEE SUMMARY: Pernut Fee: $ 35.00 Valuation: $ 360.00
State Surcharge Fee: $ 0.50
Misc.Fee: $ 1.50
TOTAL FEE: $ 37.00
APPLICANT: �'�'eld&Sons Plumbing OWNER: James Nystrom
315 Juneau Lane 1701 Madison St NE
Plymouth,MN 55447 Minneapolis,MN 55413
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
APPLICANT PERM[TEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SiQnitures Required), i-Anplicant. 1-Monthlv Reports, 1-Assessing, 1-Finance Page 1
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CITY OF OI�ONO AFPLICATION FOR PLUMI3ING PE�ZMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
GEIVERAL INFORNYATIOlvt
1. You may apply for plumbing pemuts by mail or in person at the City offices.
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 QN 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 pernut 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. Sign 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 SITE: f��_� �,Ch � �`�/--c��`� ��7`- Zip:
Owner's Name: Telephone Number:
Mailing t�ddress: City: Zip:
Contractor's Name: Gri�/'�- a= s��_� ��f�;.������ Telephone Number: ���--�/�,�=a���
Mailing Address• 3is �'�>��-� v 1���� ty: .�-a��� Zip: S�'�G/�
PLUMBING FIXTURE SCHEI)ULE
FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND 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 Misc (list)
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FERMIT FEE CALCULATI�N
1. 1.25% of Contract Price* o Minimum Fee 35.00
�'��, C�C� x .0125 $ ��� �L
(contract price)
2. State Surchar� ** Add the State Building Code Division
Surcharge to each permit. x .0005 $ ���
(contract price)
or $.50, whichever is greater
3. Postage and Handting (Only mail-in applications) $ 1.50
4. TQTAL PERMIT FEE (Add lines 1-3 above) $ ``�
��, c.�c e,
* CONTRACT PRICE 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. If any material, equipment, labor, or installation aze furnished by the owner,
tei7ant or any other party the reasonable market value of such items must be added to the estimated cost
or contract price ior 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 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 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 regulations of the State of
Minnesota, and certifies that all statements made on this application are complete, true and
correct.
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Applicant's Signature: �-4-ss� ��f�- Date: e- -��`-��
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Date
WELD & SONS PLUMBING C0.
315 Juneau Lane
Plymouth, MN 55447
. (763) 475-0296• Fax (612) 397-9370
-
" APPLlCA't'�ON`FOR�BACKFLQW PREVEN70R TEST REPORT
...._—._.
JOB ADDRESS�(BIDG A) (STREET NAME) (AVE•ST•BIVD�PKWY�ETC) (DIRECTiON N.E.S.W.N.E S.E; iBLDG NAME1
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OWNER/OCCUPANT: OESCHIPTION OF WORK:
INSTALL �;ALTER � REPAIR `, REPIACE
- ---- ---------- - -- --- — - -
CONTACT PERSON: SERVE WHAT SYSTEM:
-- �`rr,� �. �--,
DEVICE LOCATION: FL R NUMBER:�ROOM NUMBER:
��1` 1 d-�' (' V�O �i I'_ _ _----
AKE: , • MODEL: SIZE: SERIALNUMBER�
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INSTALL DATE(MONTM,DAV d VEAR): OVERHAUL DATE(MONTN,OAV 8 YEAR): TEST DATE(MONTH,DAV 6 VEAR):
r _, 5_ c 3 r �--..�—��3
CHECK VAWE CHECK VALVE PIiES.OIF.ACHOSS PRES.Dlf.WHEN S7RAiNER
NUMBER 1 NUMBER 2 NUMBER 1 CMECK � REUEF OPENS
TEST BEFORE I ❑ �AKED ❑ LEAKEO PS� �I . PSI �' �- NONE
REPAIRS G' CLOSED ❑ CIQSED " CLND
FINA�TEST i ��f GLOSEO �OSED � / PSI � �� � PSI ; ����.
C
DESCRIBE REPAIR: �/'�S��-I� � / �-s �-- �! _� _----_ --
! C, / /
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ESTIMATED COMPLETION TOTAL VALUE OF WORK: FEE: �CCI SURCHAFGE �,PERMIT FEE
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OMPANY STREET ADDRESS: .
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