HomeMy WebLinkAbout2015-00867 - plumbing � CITY OF ORONO * 2 0 1 5 - 0 0 8 6 7 *
' 2'750 KELLEY PARKWAY DATE ISSUED: 07/14/2015
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3359 CRYSTAL BAY RD
PIN : 17-117-23-41-0025
LEGAL DESC : WALLACES ADDN TO V[L OF MTKA B
: LOT 012 BLOCK 000
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCT[ON TYPE : WATER HEATER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
STATE SURCHARGE PLBG(<$500) 1.00
APPLIANCE CONNECTIONS, INC. MAIL-IN FEE 2.00
12850 CHESTNUT BLVD
SHAKOPEE, MN 55379- TOTAL 18.00
(952)445-4803 Payment(s)
Minnesota State License#: mech-MB004165 CHECK 6523 18.00
OWNER
LUZAICH, RICK
3359 CRYSTAL BAY RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only Ihe work described and does
not grant permission for additional or related work which requires sepazate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within I80 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the 5tate Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issued By Sign re Date
� FOR CTTY USE ONLY
''�" City of Orono �-/ C ZD 5 / —
¢ '� P.O.Box 66 Date Received: / � .Rermit# � W�
�,,, O 2750 Kelley Parkway p �
� F,�,"'x• Crystal Bay,MN 5532� Approved By: �� Amount$: 1 p •
a� ' , o�' (952)249-4600—titain
`�'�'asao�' (953)249-4616—Fax
CITY OF ORONO — PLUMBING PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
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GENERAL INFORMATION
1. You may apply for plumbing pennits by mail or in person at the City offices. Applications will be
reviewed and a permit will bc issued within two working days.
2. Permit cards will be sent by return mail after a review is completed. PERMTTS 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
resid;ng 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(Approval Required)
❑New ❑Additionai ❑Repairs �f Replace
J`
❑ Tn Accessory Structure`?
*You will need prior approval and may need C_l__['.(Per Orono City Code,Chapter 78,Article i�
Job Site/Owner Information:
Site ress: ��`� l �
� �
Owner Mailing Address:
Ciry: Zip:
Hom Phone:�-C I� J�"��V' Alternate Phone:
Contractor Information:
Contractor: Contact Person:
� �:-.�e Cannectiens 'nc. '/
Address: �:_3�0 CheStrlut Blvd. State Bond#: � 7
h�kopee, MN 553�9
City: '�52-445-4�� Expiration Date:
Phone_ Alternate Phone:
Insurance—Current:
1
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PLUNiBING FIXTURES BEING INSTALLED , '
FIXTURE BSMT ls 2 OTHER FIXTURE BSMT 1 2'�1D O'THER
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
PERMIT FEE CALCUI,AT�ON(S)
BASED OFF - 2002 S'I'ATE STATIJE
Yes,this section applies
The re lacement of only one Residential fixture or appliance that meets all three of the following
requirements
1. Does not require mc�ifieation te electr.cal or gas sen�ice.
2. Has a totai cost of$500.00 or less;cxcludin�the cost of the fixture 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.�0
State Surcharge $��
Mail-In Fee(If Applicable) $ UO
Total Permit Fee $�����
,..
(Permit Fees Continued On Next Page)
. _ . � 2
. , .
If above does not apply;follow gui.delines L+elow:
1. CONTRACT PRICE "is 1.25%of contract price with a(Minimum Fee of 550.00)
, x.0125 S
(contract price) {mi,nunum SSb-00)
2. STA SURCHARGE *`Add the State Bldg Code Div.Surcharge(Minimum Fee of S5.00)
• x.0005 $ .
(contract prix) ' (minimum S 5.00)
3. POSTAGE&HANDLING(Only on Mail•In Applications) $ 2.00
4. TOTAL PERMTT FEE(Add Lines i-3 Above) $ �
• " CONTItACT PRICE or JOB �OST means the actual or estimated dollar amount chazg,ed for the
pemutted yvork including matcrials,labor,profit,and other fixed costs. It is the amount to be chazged
to the customer for the work done. If any materisi,equipment, iabor or installations are furnished by
the ovmer,tenant or any other party�tlie reasor,able market value of such items must be added to the
estimated cost or contract price for permit fee purposes. In thc 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 SURCHARGE is.0005 of the contract price undcr$1,000,000 or$5.00—wh':hever is
greater. For vaivations over S1,OOO,OQd call the Building Departrnent at(952)249-4600 for tl. price.
The undersigned hereby applies to the City for i"ssuance of a Plumbing Pertnit, agrees to do all
w rk in strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies atl statemen�s made on this application are complete, true and
cotrect. '
� _ F � � �
Applicant s Signatur� _ Date: ��
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