HomeMy WebLinkAbout2004-P07485 - vacuum breaker CITY OF ORONO PERMIT
2750 Kelley Parkway - PO Box 66 Permit Number: Po�4ss
Crystal Bay, Minnesota 55323 Permit Type: va�uum sreaker
(952) 249-4600 Date Issued: siiii2oo4
SITE ADDRESS: 114 Chevy Chase Dr
Wayzata,MN 55391
PID: 36-118-23-41-0035
DESCRIPTION:
Proposed Use: Kesidentiai
Permit Class: Plumbing
Permit Sub-type(s): Vacuum Breaker
Permit Type: Vacuum Breaker
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
Lawn Sprinkler Atmospheric Back Flow preventer
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 500.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: First Mechanical,Inc. � � OWNER: Robert Langguth
7425 Louisiana Ave.N ll4 Chevy Chase Dr
Brooklyn Park, MN 55428 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STWCT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APP CANT RMI'I'GE SIGNATURE ISSUED B I NA"I'URG
Copies: 1-File(Sienitures Required), 1-Apvlicant. 1-Monthlv Reports. 1-Assessine, 1-Finance Page 1
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_ CITY QF OR011TO APFLIC�TION FOR PI..LTNIBING PERMIT
Box 66 (2750 Kelley Parkway)
Crystal �ay, MN �5323
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City offices.
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 the State Code requirements.
6. All work must be inspected and air tested before it is covered. Call (952) 249-4600. 24-hour notice
required.
Instructaons Complete all items on this application. Compute the permit fee. Sign and date the
;, certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have
questions, call (952) 249-4600.
Please check one: New ��% Addition Repair Replace
r,� Residential Comrnercial
JOB SITE: � l�} � ( r` .��� �� �� � � �� , �~ �r,,;� Zip;
Owner's Nam �`` k� �,,,-�� r��5,�; �-��' Tele h n ;� � �,� ,�= �� =� ',,
e::% I�� -,�,�����-�: p o e Numher i_�� � ,t'� f,
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Mailing Address: � , , , .�;� ``� City: Zip:
Contractor's 1�1�ne �,, " : '; ,-,; , � ,J:.�:� Tetegho�e Number �.j� ;r; .,.� , �` �
1Vlailing Adciress ; '_,/ � = ` �, , , � .,_���ity:' �-;�. , �%Zip �- :� ��'���
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F�LTIVIBIN�- FIXT�tE SC�iEDULE
FIXTUI�E BSMT 1ST 2IVD OTHER FIXTURE BSMT 1ST 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavato Sewer E'ector
Bathtub Laund Tra
Shower V�asher
Kitchen Sink Vl�ater Heater
Dis osal Water Softener
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Dishwasher Wet Bar
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Sillcocks Misc (list) %
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I'ERMIT FEE CALCULATIOl�(S)
` 2002 State Statute ❑ Yes, This Sectfon Applies
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' The replacement of a Residential fixture or appliance that meets all three of the following
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requirements:
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t 1) Does not require modification to electrical or gas service.
'• 2) Has a total cost of$500.00 or less; excludin� the cost of the fixture or appliance:
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3) Is improved, installed or replaced by the homeowner or licenced contractor.
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� Skip next section; Cost of Permit $ 15.00
� State Surcharge $ .50
� Mail In Fee $ 1.50
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� If above does not apply, follow guidelines below:
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� 1. Contract Price* is .0125 %o of job with a Minimum Fee of ($35.00)
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F x .0125 $
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�? (contract price) (minimum$35.00)
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� 2. State Surchar�e. ** Add the State Building Code Division a (Minimum Fee of$ .50)
�" x .0005 $
� (contract price) (minimum$ .50)
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�'; 3. Postage and Handling (Only mail-in applications) $ 1.50
4. TOTAI.,FE�2MIT FEE (Add lines 1-� above) $
* CONTRACT PRICB or JOB COST means the actual or estimated dollar amount chazged 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, Iabor, or instailation 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 purgoses. In the event tkat 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 SURCI-If4RGE is .0005 of the contract price under$1,000,000 or $.50 - whichever is greater.
For valuations over $1,000,000 call the Department of Inspection Services for the price.
The undersigned hereby applies to the City for issuance af a Plumbing Perm.it, agrees to do all
- work in strict accordance with the ordinances of the �ity and the regulations of the State of
Minnesota, and certifies that all statements made on this application are complete, true and
correct. �
E4pplicant's Signature: __ =- - Date: _ � ', !��
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