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Home My WebLink About2012-00507 - plumbing CITY OF ORONO * z 0 1 z - 0 0 5 0 7 * � 2750 KELLEY PARKWAY DATE ISSUED: 06/07/2012 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 190 CYGNET PL PIN : 04-117-23-22-0021 LEGAL DESC : SWAN LAKE ADDN : LOT 004 BLOCK 003 PERMIT TYPE : PLUMBING(>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : FIXTURES- MULTIPLE NOTE: 1 KI"TCHEN SINK 1 DISPOSAL 1 DISHWASHER 1 WATER HEATER VALUAT[ON OF PLUMBING 1900 APPLICANT PLUMBING FIXTURE FEE 50.00 H[LLCOR PLUMBING STATE SURCHARGE PLBG(VALUATION) 0.95 53 TERRACE RD NE TOTAL 50.95 ST MICHAEL, MN 55376- (763)688-0342 PAID WITH CC# 2293 Minnesota State License#: PC645327 OWNER FREEMAN, MR. & MRS. 190 CYGNET PL LONG LAKE,MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. 'Chis permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is nsible for assuring all reyuired inspections are requested onf ance with the State Building Code.This pemiit may bc revok at a �me Dr ue cause. �� iz�t� � l l Applic t Permitee Signature Date [ssued By Si ture Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. FOR CITY USE ONLY � ,¢�� City of Orono O* O P.O.Box 66 Date Received: Permit# �;;-� � 2750 Kelley Parkway � ��,_ T� � Crystal Bay,MN 55323 Approved By: Amount�: �� '"� o� 952 249-4600—Main �u� �'��, ( ) asxo$ (952)249-4616—Fax CITY OF ORONO - PLUMBING PERMIT (All Commercial Permits Must be Approved by the State Prior to City Approval) htt ://w�ti��.dli.mn.�ov/CCLD/PDF/ e �lumb lanre��a �.�df GENERAL INFORMATION l. 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 RECENE 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 pernut 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 Apply) ; S,g Residential ❑ Commercial(Approval Required) ��-- Q 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: ___ �d ��/9 hc � �/�C'� Owner:G t,l9 ha�z� � S�S vM/ ��t�rtu/Mailing Address: S�'� City: G!�-i� �•g.G,o Zip: .5��3.5(p Home Phone: Alternate Phone: Contractar Information: Contractor: ��/c-'o P v►..T �h Contact Person: �` �F�� y Address: S3 �l/'�¢CC �.� i(/(� State Bond#: �e ��S 3 � � City: 5��'��4�1 Zip: 'j'�Expiration Date: !2 I 2c�l Phone: ��o �-�v4�'D?y2 Alternate Phone: ❑ Insurance—Current: �fST �t.-�� 1 � PLUMBING FIXTLTRES BEING INSTALLED � FIXTURE BSMT 1 2� OTHER FIhTURE BSMT 1' 2' OTHER TYPE FL FL TYPE FL FL Water Closet Floor Drains Lavatory Sewer Ejector Bathtub Laundry Tray Shower W asher Kitchen Sink Water Heater � Disposal � Water Softener Dishwasher � Wet Bar Sillcocks Miscellaneous PER�!I1T FEE CALCULATION(S) ' � � � � BASED OFF - 2002 STATE STATUE � �� ❑ Yes,this section applies , The replacement of only one Residenrial 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; excludine 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 Pernut $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ (Permit Fees Continued On Next Page) 2 . � �; �`x '� PERMIT FEE CALCULATION(S �=JOBS OVER$500.00 �,.�� If above does not apply; follow guidelines below: 1. CONTRACT PRICE *is 1.25% contract price with a(Minimum Fee of$50.00) �'! 7�D x.0125 $ (contract price) (minimum$50.00) 2. STATE SURCHARGE x.0005 $ (contract pnce) 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 fumished 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 City may request the submission of a signed copy of the actual contract. �.,,� �;��`�`�� ,� �_ ��' ��,,;��; F��TBING PERMTT " ° � 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 stat s ade on this application are complete, true and correct. Applicant's Signature: Date: � � �� 3