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Home My WebLink About2009-00544 - vacuum breaker � � CITY OF ORONO PERMIT IYO.: 2009-00544 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 09/OU2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 4040 DAHL RD PIN : 07-117-23-11-0021 LEGAL DESC : PIRATES COVE : LOT 017 BLOCK 001 PERMIT TYPE : PLUMBING (>$500) PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : VACUUM BREAKER NOTE: INSTALL(1)RPZ APPLICAIYT PLUMBING FIXTURE FEE(<$500) 15.00 NORTHSTAR MECHANICAL STATE SURCHARGE PLBG (<$500) 0.50 30299 109TH AVE HANOVER, MN 55341- TOTAL 15.50 (763)498-0009 OWNER LEPPLA, MR& MRS JOHN 4040 DAHL RD MOUND, MN 55364 AGREEMENT AND SWORN STATEMENT The wark for which this permit is issued shall be performed according to the approved plans and specifications,applicable Ciry approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. � /7 � C / � / �r / / ppl' nt r � ignat e Date Issued By Signature Date SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE. � , , , • Q��IT USE ONLY � p,�` City of Orono � �/ O� `rO P.O.Box(i6 Date Receive v� � Permit# Q�OD� �f �;;,, , � 2750 Keliey Parkwa�� j�'��=;. �� Crystal Bay,MN 55323 Approved B � ��• Amount$:�5� ��fi��r$�G1 (952)249-4600 CITY OF ORONO -PLUMBING PERMIT (All Commcrcial permits must be approved by the Building Official or Inspector) 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 MDST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3. Plumbing pernuts 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 Apply) esidential ❑ Commercial(Approval Required) [—I �'aw ❑ Addirional ❑ Repairs ❑ Replace ❑ In Accessory Structure? *You will need nrior approval and may need CUP.(Per Orono City Code, Chapter 78,Article IV) Job Site/ Owner Information: Site Address: ��'��C' ��" �\� Owner: �� '��L R" Mailing Address: ��``�� City: �v��C"i Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: /j/r'7%'�i�7`!f� yy/c'c�, Contact Person: ��>--�Ei , Address: ��.� /o s 7h ��t' �� State Bond #: �OCr�C��1(�� s�yl City: �f,'�� '1 n Zip: /� Expiration Date: //-� � `� D� Phone: ��3 -�t�'� --Qc��j Alternate Phone: GS�-�y 8 -,,� �D'7 ❑ Insurance- Current: __�T��' _ 1 * � � � , PLUMBING FIXTL7RES BEING 1NSTALLED ; FI}�TURE BSMT 1 2' OTHER FIXTURE 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 Disposa] Water Softener Dishwasher Wet Bar Sillcocks Miscellaneous ��r P �, �'2 �st�/�� PERMIT FEE CALCULATION(S) ! BASED OFF- 2002 STATE STATUE ❑ Yes, this section applies The replacement of a 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; excludino the cost of the fixture or appliance: and 3. Is improved, installed or replaced by the homeowner or licensed contractor. Skip next section,if this applies; Cost of Permit $ l 5.00 State Surcharge $ .50 Mail-In Fee(If Applicable) $ 2.00 Total Permit Fee $ (Permit Fees Continued On Next Page) � r � , . P�RMIT FEE CALCULATION(S —JOB`S 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$50.00) x.012� � (contract price) (minimum$50.00) 2. STATE SURCHARGE ** Addthe State Bldg Code Div. Surcharge(Minim�m Fee of'�.50) x .0005 $ (contract price) (minimum$ .50) 3. POSTAGE 8�HANDLING(Only on Mail-In Applicarions) $ 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 City may request the submission of a signed copy of the actual contract. ■ ** The STATE SURCHARGE is .000� of the contract price under $1,000,000 or $.50—whichever is greater. For valuations over$1,000,000 call the Building Deparnnent at(952) 249-4600 for the price. PLLTMBING PERMIT APPLICATION.AGREEMENT 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 statements made on this application are complete, true and correct. , � Applicant's Signature: �� aG G�" Date: �� 3