HomeMy WebLinkAbout2013-01261 - water heater � • CITY OF ORONO * 2 0 1 3 — 0 1 Z 6 1 *
2750 KELLEY PARKWAY �ATE [ssuEu: 12/03/2013
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2590 COUNTRYSIDE DR
PIN : 04-117-23-1]-0010
LEGAL DESC : COUNTRYSIDE MANOR 2ND ADDN
: LOT 002 BLOCK 002
PERMIT TYPE : PLUMBING (<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER HEATER
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APPLICANT PLUMB[NG FIXTURE FEE(<$500) I5.00
BAX"I�ER MECHANICAL STATE SURCHARGE PLBG (<$500) 5.00
PO BOX 591
ELK RNER, MN 55330- MAIL-IN FEE 2.00
(612)227-6710 TOTAL 22.00
Minnesota State License #: 066036 PM
OWNER
FITLD, JAMES&CHR1S"C[NE
2590 COUNTRYSIDE DR
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
i�he N�urk fur���hich this perniit is issued shall be performed according to
the approved plans and specifications,applicablc City approvals,and the
State f3uilding Code. 'l�his permit is for only the work described and does
not grant permission for additional or related work which requirrs separate
permits All provisions of laws and ordinances govcming this typc of work
shall be compicd H�ith�a�hether or not specitied herein.'fhis permit will
expim and become null and void if construction aud�onzed is not
commenced within 180 davs of the date of issuance,or if construction is
suspended for a period ot� 180 days at any time after work has commenced.
l�he applicant is responsible for assuring all rcquired inspections are
requcsted in conformance with the State Building Code.This pennit may be
revoked at anv time for due cause-
1���'.r' _" � � / /
Applicant Permitee Signature Date Issucd I3v Si ature Date
SEPARATE PERMI"I'S REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
` FOR CTI'Y USE ONLY
,�O O City of Orono
/ P.O.I3ox 66 Date Received: Permit tl
� 2750 Ke11ey Pazkway
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( 1 Crystal Bay,MN 55323 Approved By: Amount$:
i f (952)249-4600-Main
� a i (952)249-4616-Fas
y� c.% CITY OF ORONO—PLUMBING PERMIT
��k�SH��% (All Commercial Permits Must be Approved by the State Prior to Ciry Approval)
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GENERAL INFORMATION
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. Permit cards will be sent by return mail after a review is completed. PERNIITS ARE NOT
VALID UNTIL YOU RECEIVE A PERNIIT. WORK 1ViUST 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
�esidential ❑Commercial(Approval Required)
r �
❑ New ❑Additional ❑Repairs �eplace
❑ In Accessory Structure? ,
*You will need prior aaaroval and may need CUP. (Per Orono City Code,Chapter 78,Article IV)
Job Site/Owner Infonnation:
Site Address: � �2.r"�"✓ ; � �` � � �
1 �
Owner: �j �4 c l� Mailing Address: "� ��Z_�L ''
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City: T�r"� Zip: rj����
Home Phone: Alternate Phone:
Contractor Information:
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Contractor. '�G'��'�' � 1� ��,�-'��.�A� �"'��tact Person: t,�'� � ��n1 V -�� l�
Address: �� i?C 2`) , ' State Bond#: �-��,,. L..��� �
� � , 2,�� .
City: li� ���� Zip: �' Expiration Date:
Phone: ���`' ������' �( �� Alternate Phone:
❑ Insurance—Current: J, �% �r�? -� �
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���^�-T� i
1 �u�,�r �n.�v��,��—��C� '�'�'..
PLUMBING FIXTURES BEING INSTALLED
FIXTURE BSMT 1 ST 2 � OTHER F[XTURE BSMT 1 s� 2 O'I`HER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub La undry Tray
Shower Washer
Kitchen Sink Water Heater '' �
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous
PERNIIT FEE CALCULATION(S}
BASED OFF - 2002 STATE STATUE
� Yes,this section applies
The repiacement 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;excludin�the cost of the fiacture 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) $ 2.00
Total Permit Fee $�
(Permit Fees Continued On Next Page)
2
PERMIT FEE C�4L,CULATION S —JOBS OVER$500.00
If above does not apply;follow guidelines below:
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of 550.00)
x.0125$
(contract price) (minimum$50.00)
2. STATE SURCHARGE
x.0005 $
(contract price)
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
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 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 Ciry may request the submission of a signed copy of the actual contract.
PLUMBING PERMIT APPLICATION AGREEMENT
The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all
wark in strict accordance with the ordin ces of the City and the regulations of the State of
Minnesota, and certifies that a11 statem `ts made on this application are complete, true and
correct.
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Applicant's Signature: � Date:
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