HomeMy WebLinkAbout2015-00255 - plumbing , , CITY OF ORONO * 2 0 1 5 - 0 0 2 5 5 *
2750 KELLEY PARKWAY DATE ISSUED: 03/02/2015
ORONO, MN 55356-
(952) 249-4600 FAX: (952 249-4616
ADDRESS : 3435 CRYSTAL BAY RD
PIN : 17-117-23-43-0120
LEGAL DESC : WILEYS PARK LAKE MTKA
: LOT 003 BLOCK 001
PERMIT TYPE : PLUMBING(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCT[ON TYPE : FIXTURE
NO"I�E: WATER HEATER
VALUA'i'ION OF PLUMBING 1300
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG (VALUATION) 0.65
BENJAMIN FRANKLIN PLUMBING MAIL-IN FEE 2.00
1424 3RD STREET N
MINNEAPOL[S, MN 5541 1- TOTAL 52.65
(763)755-6468 Payment(s)
CHECK 22945 52.65
OWNER
BROWN, SCOTT
3435 CRYSTAL BAY RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shail be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of l80 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permit e Signatnre Date Issu By Signature Date
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FOR CITY USE ONLY
�O A'O City of Orono
�y P.O.Box 66 llate Received: Vermit#
2750 Kelley Parkway
Crystal Bay,MN 55323 ��.- Approved By: Amount$:
(952)249-4600—Main 3 '
y k (952)249-4616—Fax
�' c.` CITY OF ORONO—PLUMBING PERMIT
���Est{o�� (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 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. 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 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 A(I That A 1 �
���esidential ❑Commercial(Approval Required)
❑New ❑Additional ❑Repairs ❑ Replace
❑ In Accessory Structure?
*You will need prior approval and may need CUP.(Per Orono City Code,Chapter 78,Article IV)
Job Site/Owner Information:
Site Address: �� �� (�'��Cl( /�LCI� � D'
_1 !/
Owner: GoT� ��UW� Mailing Address:
City: ���41? � Zip: � �j �J�'l�
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Home Phone: 7��^�J lJ ���`� � Alternate Phone: --
Contractor Information:
Contractor: ���1�/Z!h(G��h �" l��I�Contact Person: ������� ��G�
Address: � �df/ I�tr�l �Stat��na#: I��� `/ � � v3
ssya8'
City: ����(���%� Zip: Expiration Date:
►�
Phone: �1� ��3�`��Q y Alternate Phone:
❑ Insurance—Current: �/l,l/��S�G�/Ze�
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�.F s PLUMBING FIXTURrS BEING INSTALLED
FIXTURE BSM"1' 1�� 2ND OTHER FIX"I'URE i3SM'1' 1�� 2" OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater 1
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous
� � . PERMt"I, FEE CALCULATION(S) � �� � � �
� � ��� '�. BASI;D OFF — 2002 STATE S"TATU� �
❑ Yes,this section appl�
The replacement of only one Reside tial fixture or a liance that meets all three of the following
requiremerts:
1. Does not require modification electrical or gas service.
2. Has a total cost of$500.00 or les • excludin�the cost of the fixture or appliance: and
3. ]s improved, installed or replaced b the homeowner or licensed plumbing contractor.
Skip next section, if this applies; t of Permit $ 15.00
State urcharge $ 5.00
Mail-In (If Applicable) $ 2.00
Total Permi ee $
(Permit Fees Continued On Next Page)
2
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PERMIT FEE CALCULATION S -JOBS OVER $500.00 `''
If above does not apply;follow guidelines below:
1. CONTRAC7' PRICE * is 1.25%of contract price with a(Minimum Fee of$_50.00)
� �� x .0125 $
(contract price) (minin um$50.00)
2. STATE SURCHARGE
�� � u x .0005 $ ° �
(contract price)
3. POSTAGE& HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines l-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. ]t is the amount to be charged
to the customer for the work done. If any material, equipment, labor or installations are furnished b,�
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 City may request the submission of a signed copy of the actual contract.
��� � PLUNTBING PERMIT APPLIGATION AGREEMEN"T �
The undersigned hereby applics to the City ior 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.
Applicant's Signature: Date: �� ����
3