HomeMy WebLinkAbout2016-00391 - water softener ` CITY OF ORONO
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2750 KELLEY PARKWAY DATE ISSUED: 04/19/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 800 BROWN RD N
PIN : 34-118-23-11-0007
LEGAL DESC : REG. LAND SURVEY NO. 1275
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER SOFTENER
NOTE: NEW WATER SOFTNER
VALUATION OF PLUMBING 2549
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 1.27
CULLIGAN SOFT WATER SERVICE CO. MAIL-IN FEE 2.00
6030 CULLIGAN WAY
MINNETONKA,MN 55345- TOTAL 53.27
(952)912-7379 Payment(s)
CREDIT CARD 5107 53.27
OWNER
NORTH, MICHAEL&SARA
800 BROWN RD N
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
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 l80 days of the date of issuance,or if construction is
suspended for a period of 180 days a[any time afrer work has commenced.
The applicant is cesponsible for assuring all required inspections are
requested in conformance with[he State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issued By Signature Date
___, 04/19/2016 10:�1 FA� 95293�5049 CULLIGAN �NTKA �005
FOR Cl'�'X CJSE ONL`Y
� City of Orqno (� <z �
O�` '�Q P.O.Sox 66 Aate Rsceived� ✓{ 1 l Permi�# �2���` ✓�
a,?�t�„ 275o Kefley Parkway � . �
`��Z�`',�''� � Crystal Bay,MN SS323 Approved By: Amount S:��
,��a/ (952)244�600 ,
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C�TY OF ORONO-p�UN��G PERNIIT
(.411 Commercial pemtilS must be approved hy th�Bu ilding 01Ticixl or Inspec[ar)
GENERAL IN�'ORMAT'ION
1. Yov may apply for plumbing permits by mail or in person at the City of#ices. Applications will be
revicwed and a permit will be issued within two working days.
2. Permit cards will be sent by return mail after a review is completcd. PER'vlITS A,RE NbT
VALTb UNTII.,YOU�CEIYE A PERMIT_ W�RK MUST tiOT BEGI?V L''v'TIL�'X��
P�RM1"�'CARD IS pOST�p QN TFIE JOB SIT�.
3. Plumbing permits may be issucd ON'LY To liCensed plumbing contractors and to p[operiy owners
residing in the dweiling_
4. When any new construction or rernodefing is involved,a separate buiiding permit must be
obt�incd.
5. All work must be done in accordancc with State Code requirements.
6. f111 work must be inspected and air tested beforc it is covered, Call(952)249-460D.
(Z4-48 hour notiCe required)
TYl��OF PERMIT
Checic All'r'hat,A, I
�Rcsidential ❑CommeTcial(Appcoval Requircd)
��Iew �Additional ❑Repairs ❑}teplace
❑ In Accessory Structure? ;
*You will necd rior a roval�rld may need CIJP.(Per Orono City Code,Chapter 78,Article IV) I
Job Site/O�vner Znformation:
Site Address: �
Orwner: ��G'u � 1( Mailiz►o Address: '
City: Zip: :
�
XCame Phone: lti� -'�]��j"�p�,���,,� Alternate Phane:
Contractor Information:
��'���t��� iV i N G Contact Person:
6�30 CIJLL.��AfJ 1�,qY ;
Addres��N��- , StatE $ond#:
Y
(�52) 933-7200 °
C�rY� Zip: E�piration Date: i
Phone: Altemate Phone: �5 a`q '���31� '
� Insurance-Curr�nt: �
1
__ 04!1�i2016 10:a1 FA� 95293a504� CL�LLIGAN MNTKA [�006
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i �- �,� •r�-��r.r�� ,^, ,' � �'��'
FIXTURE �SMT J 2 OTHER FIXTURE BSMT 1 2 OTHER
�'�Y'PE FL FL 1"YP� FL FL
W ater Closet Floorl7rains
Lavatory Sewer�jector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink 'Water Heater
Disposal 'Water Sofrener
Dishwashcr Wet�ar
Sillcoeks Miscellaneous
�i.��.��f.�;.—i��.�Ap.i�l;���r�d:1. :��e`.�_�iM:,;r. ����.rl��� d .IY .rv�l�� �� !,Ir'!"'�":I�i rql"` ',�e"1Pr;,`.j�;I�yi�i�I,.M1�,:� �����,�,�;ii��
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❑ Yes,this stction appli�s
The replacement of a}Ze�idential flxtUre qr analiance that meets alI three of the following requirements:
1. Docs not requ'ue modification to electncal or gas serviee.
2. Has a total eos�of$500.00 or less;exeludina the cost of the fixture or appliance:and
3, ls improved,installed or replaced by the homeoumer or licensed contractor_
Skip next section,if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) � 2.OQ
Total Permit Fee �
(Permit Fees Continued On Next Page)
2
04/19/2016 10:a2 FAX 952flaa5049 CULLIGAN MNTKA C�007
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'�'���r'-„�t � ,,��; � ,�t���J ���,- ����LE;�;��':�� , �T.��1�T':S�`�`.�`.`�,0�3�;Q�1���5'bQ.00 ,�, ;s,,. ,� �-�,�
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If above does not apply;follow guidelines bclow: 1
1. CONTRACT PR�CC *is 1.25%o�contract price with a(Minimum Fee of�50.00) _ �'V
��,'� � ��
x.o�as$
{con[rsa pncc) (minimum$SO.DO)
2. STAT�SYITtCHARGE **Add the SCate 13Idg Code Div. 5urcharge(Minimum Fec ofS5.00)^ ./'
�L
x.0005 $ � �
(contrnc[priCe) (minimum$ 5.00) �
3, POSrAGE&HANL]LING(Only on Mail-In Applications} $ 2.00 �
� � .
4. TOTAL P�RMIT FEE(Add Lines 1•3 Above} $ �
■ " CONTRACT PRICE or J0� COST means the actual or estimated dollat amount charged for the
perm�tted work including matcrials, IAbor,profit,and other fiaed eosts. [t is the amount to be chargcd
to tho customer for the work done, if any material, equipment, l�bor or installations are furnished by
the owner,tenant or any other party,the teasonable market value of such items must be added to the
estimated cost or contract pricc for permit fe� purposes. In thc event that therc is a dispute on thc
amount of the job cost,thc Ciry may requcst the submission or a si�ned copy o'C She Actual contraeC.
• x*The STATE SURCHARCrE is.0005 of the contract priee under$1,000,0�0 or$5.00 T whichevei'is
greater. For valustions over$1,000,000 call the Building Department at(952)249-4600 for the price.
��•af:,9x.'�i-',�? �.��'U'^'Ui.P+`"•^,r. " .�.5 '' ,� ,.�',. , .. ,':' ',r:; '.y. _.,.., 'M!i'y , ',..''i,Yr,,..,, _ � ,�,;,+' .,'"l,l.ij'�y",;1.;�i{;r:E11?���;��;�,'�,5�{�;j.�Ur,���;
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The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all
work in strict aeeord�nce with the ordinances of the City and the regulations of the State of
Mins�esota, and eertifies that all statements madc on this application are complete, true And
correct.
AppIicant's Signature: Date: � �' U�
' ,.�
R�set For�,,
3