HomeMy WebLinkAbout2016-00746 (Water Softener) � CITY OF ORONO * Z 0 1 6 - 0 0 7 4 6 *
2750 KELLEY PARKWAY DATE ISSUED: 06/27/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1261 ARBOR ST
PIN : 10-117-23-31-0032
LEGAL DESC : CRYSTAL BAY MINNETONKA
: LOT 000 BLOCK 002
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENT[AL
CONSTRUCTION TYPE : WATER SOFTENER
NOTE: WATER SOFTENER
VALUATION OF PLUMBING 500
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.25
CULLIGAN SOFT WATER SERVICE CO. MAIL-IN FEE 2.00
6030 CULLIGAN WAY
MINNETONKA, MN 55345- TOTAL 52.25
(952)912-7379 Payment(s)
CREDIT CARD 5107 52.25
OWNER
PETERSON,F& B
P.O. BOX 164
CRYSTAL BAY, MN 55323-
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 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 consCruction 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 afrer work has commenced.
The applicant is responsible for assuring all requircd inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
C Yl��� , � �� � ��- �
Applicant Permitee S ture Date Issued Signature Date
06/27/2016 08:�7 FA� 952933504� CtiLLIGAN �NTI{A �002
f
• te;�:.ReceivedR,Cl,n''USE ON �..°,""„°:i;°,;'',;r;
�p� City of Orono , LY ��
Q P.O. Box 66 pa ��r�, r.j/h
,�. . „
y r ��� ,�„
",,��,,,.; „�.;,,'��;I "1;.,, . ,,r�;.,, .,.,!',,;��,r,;r.,.i,r.,�.�..i . ,� „,� .,,.
2750 Kelle Parkwa � i �
��' � Crystal Bay,MN 55323 k'erlrlt# A�/� � J�
y�'f_ , 0.�(.� (952)249-4600—Main �pP��ov�d �y'.'� i.. � ���� , i� �i � ��i.�.�:,��.
"'� sHo �' (952)249-4616—Fax i . I"�'� �I I ',, ,
� � �i
Am"punit$.' i i � �1..r��r:� i���..,�i, ,.
,,•
C �F ORONO— PLUM
ITY BING P I
ERM T
(All Commercial Permifs Must be Approved by the State Prior to City Approval)
http://www,dli.mn.qov/CCLD/PDF/pe plumbplanrevapp.pdf
,,,.. �,,, „�.
,�.:,
,�� , '�. ., ;�I, .I,�,,.�,�. ,I�,�. °•', �� I�II��:�I��������I�.�.�,,.. I�irinC :n:;���I�,II�"I:i}. '� .
IGENERAL",INF:QRMATION ���;,��. � �� �� �� �,` 'ti�: �..�.u„��� I� V����:�' ���. !�' .. ;�:,�•
'�, `�.�
may apply for plumbing perm�ts by mail or in person at the City affices. Ap lications wi, ' ',
1. You p' II be
reviewed and a permit wi(I bE issued within two working days.
2. Perm�t cards will be sent by return mail after a review is completed. PEF2MITS ARE NOT VALID
UNTIL YQU REC�IVE A PERMIT. WORK MUS7' NOT BEGIN UNTfL THE PERMIT CARb IS
POSTED pN THE.f06 SIT�.
3. Plumbing permi�s may be issued ONLY to IicensEd plumbing contra�tvrs 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 accordanc�with State Gode requirements.
6. All work must be inspecfed and air tested before it is covered. Cal! (952)249-A�600.
(24-48 hpur notice required)
,„,„,,, „,..�....... ..... ..„. . �, .,,.,.,.,,. . . ., , „� ,,,,...,, , ,.,,�,.,,.,„ .,,. ,,...�.,, , .. .,..... .,.. ,
.��.!��n��.r�.br•,..„��„�:���..��„�„�„�,���:,,.,�,r�.�����,.I.�;��n���,�.���.�..�.��IJuen��.,�������;�,e� .�� � ,��J�.I,ill�.�„n� �� ,� ��,n,b,�ln�� ���.����,�,�i b��.��..�a„�„�i�,�,��,���m�,��u.n,.�n�nn,�� ���.,,,,�,�,�„��.,,,,;;1:11�1'I:I':;���61�,����
„��,������i,�,�,�,..�„� , � , . �,,,,��„�,�,�ui,�6,1�,��. .� ����������„���.���a� �N n
,,.�I.�„,�;,,'..���.6,��„�„�„�. � ����.,��,,,�,�,�.,�,�,�,���,.��,!„�, ,� ,i � ( � I I,,,wiri•n�m1,6b������xI.��L�„�„���i,l•,�n,��J��l,�r�il
II..,..,J,.,,.�..,i�,G U.,,��I,�,,.�, . � I �
��,,,,..�.,,,.. .,T1' .��,�F��;PERMIT Checkl�ll.That.� n� 1 �,I,. �,.�,;,�,,,�r,l,,,���.��1,,,�,��r��,�.,.���.,,��.�.,.�,,,�,.,,,,, ,�,.
, ,,�,. . ,., ,.,...,,..,., ,, �,,,.�,.,P ,.. ;��w�,,� ,,,�, „��,����,�.� ���������,,
.,.I,I.,;"n�..w,�.e.,,,l I���,�f „fl���.��.,,,,,,,,,, ,,,,,1��..,,.1,..��,�.�i���,��� ,.,,,.. , .I., ...., _..,, , 1..,,,.,.,. ,,. ••., ..,�,. , ,��ph'Y!. ,y�l�i�l��,,,�,��',:II:;;,6��1„I ���I�.��.��.II�.���,�.I�,,, ,��III;'ICII:;�'�u'�I:�,, '':I;I:,
�esidential ❑ Commerciaf (Approval Required) [Backflow De�vice: �Av� ❑PVB]
i �
�New ❑Additional ❑ Repairs ❑ Replace
❑ In Accessory Structure?
"You wilt need prior approvaf and may need CUP. (Per Orono City Code, Chapter 78, Article 11n
� � � �.��,� � . � „�� �
'Job�Sife'I�Qwne'r Informat�on ' " , ,;;; ',
S�te Address: Ar br �"
Owner: �r�.�`C ��S o� Mailing Address:
City: Zip: S��S�n
Hame Pho�e: �'a, -��\ ,: a`IO�o Alternate Phone:
,., ,.�� .:.,.,„ �,., „.,.,.,„� . , . .: ,i..,......,,.„ ,,,, ,,.,�,I„,.„'�
I,�� �..� .��� �...,��,.....,��� _.�:�!����.a1iH�i�nl,I�S�I����.li���:,i,�6li�,l�,�.11i����'�;���Ibidin��wtl,�uu,��l�l'',..��.',.Hli����.��
, uii ,�',����.,�
Contrac#or lnformation ,; ,.,� ,� �� , .„� ,�� ,� , , .,
„..., � .,, � � i��I����� „ ,.
Contra�#p�-� Contact Person:
Address: 603� �UtLIGAN WAY State Bond #:
City: �----�` �g�Z� 933-72Q0 Zip: Expiration Date:
Phone"�^`-� Alternate I'hone:
❑ Insurance— Gurrent:
Page i
06/27/201� 08:�7 FAX �529��5049 CtiLLIG�N M�TKA C�00�
• � '..,,v��.. �,,�,�, .�.��, }-� ,.. T��� ,�,�„� .,�;. ,,,,�„ ,�.,,�,�,
���I ..l I01�:i�;I�" ,I;i;l;il�.�i •i Iy�7- !� [1 I i� �'" +9,,'I n' �6'{S�' nI���CkC'�L.i. �. ,.,�a
��,,S,�d, '��Crv1,4 �• r i��,l'1G I .�„� �,1/?"'4..� E NV S �LLEQ�L II ' � .�. I � I,",;�"`�I ,.i.� j
� 7 � �'
,ir nao�i�lY���� ,m��f�„�u�� N��m�i,dln�. �!i � �P��IJ�M.��Nl7 R_E��:� �� I�,�. �' ,�l"rI'�W,��7.'{'C �i.� ''I�II��;.I I��X�Iy,inn�:•����dn
FIXTURE BSMT 1s' 2"o OTHER FIXTURE BSMT 1sr 2ND �jHE�
TYPE Floor Floor 1YPE Floor Fivor
Water Cfoset Floor Drains
�av�tory S2wer Ejector
Bathtub Laundry Tray
Shower Washer
KitChen Sink Water Heater
Disposal Water Softener 1
Dishwasher Wet Bar
Sillcocks M iscel[aneous
,��,. , � ,� ,�,, ,,, , , , ,,, ,,,.: �, ... .. „. , ,.
i i n iu tf i ii n � ��i � �n� i �I, �� �� �� , ���,,.��i' �....,"�, "" . .. ..,,�� .�, , ��� ..�.� ,. �.��� ,��,.��,�.���.n �nuu,.w�������,�
nu� ��„ u�u����,n,�����i„�����,ui�����,.�,�.��,.��n�v,
I �Y�8,�, �u ,Ii ��l i�i �ni��n�J��nriinli{i, iiu � I .dn„ �R6�i�n,N �fu8,��^�.dl'�{in�'..IwX�ih.l�.�vi��tre,��x.1��� �m�n,am���,..�,��u��Y;!�I 1$���i :!�II�"��a����'k;��`fo
1.,1��. l,l�,d� IIJNI,R� ,�„1d,�,wV�,,�a�� 81�.,.,�,�,��, �„�.,,flh.,.,,�� ,i,�C1J�,, ,tl; s . �.. „�I,�,. ��,,I,� � .G�„ 6. 1 � �.
ii n ��i���a.9 i��l� �i,ll� i I c:,l(� ::,1' �d� ,�E,ie,i i nf,8J" �n��,•.aa, m�ar�lmi, ,.j^:.,�..�, ,.�w
��,ie�i„ir.
!'Pllilln{uu1�l'in.l��!��.��.A�S�.Il�,i�n��l �uiLi��� ����� ° � lexnwiwiii�i�i��i�ln��� I "�i�G4��,���,'. ,� ���. a" ,In��roN�,U�����i.�m,,,��,.,.,��6„�.d,,,,�Y.,6,�,�w.�,����1�.,.I,
nu ani uuhiAmda'�i�mil�en., �•� ��:� '..�i�".���.�,;;"� fl ! I f'�P'll
� ��q ,����,� �,,,.��, � i 4 �I rz ,Gi��....ac,E....,......i�F...,.,..,�,.,,,.�„ ..,...,
1. CONTRACT PRICE " is 1.25% of contract price with a (Minimum �ee of�50.00)
x.0125 $
(cantract price) (minimum �50.00)
2. STATE SURCHARG�
x .OQ05 �
(contract price)
3. F'OSTAGE � HANDLlNG (Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FE� (Add �ines 1-3 Above) �__ 5_a� ��
" CONTRf�1CT PRICE or JOB COST means the actual or estimated dollar amount charged fior the
permit�ed work including materials, labor, profit, and other frxed costs_ It is the amount to be charged to
the customer for the work done. If any material, equipment, labor or installati4ns are furnished by the
owner, tenant or any other party, the reasonable market v�lue 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 fihe
amount of the job cvst, the City may request the submission of a signed copy of the actual contract.
m."� -,o,�•�I�:��J�:.,�,,�.,������,i��,��e�:,p�����,iiL��ny�u�n,y,n�a i ui� ����i �ei � i,6 ,.�� ii�u..��,.'I Irl{�"�' tii;l��•�r. ,,�i �ni��mm�4�m J4 4'� 'i;�n i r i�.{L'I i'i IS� "
v;m��i ,f:� �.o�rv������....,��.vn,� 6�„a �l.::,� �n lo� �'�`� p y7 p �,��'., (�� C—, y �n y�II
. ,
����,���.In��ll��%,.IJJi,,i„,,,�,',��,�.,I,,P�'� I��I, ��1�„� ,,9 6�I�,,� . p� �� , . , 1,., II " ' ':�,.,..;; . lii' � d {�,Iti�.,�,�,m� al„�!m .�,!n, nI���$�.d `.�C, I:'}
� ,, ,,. ,��� ,,,,,�,.,. „,.,,.„�,.;..'I„.... ��
�'�`ytl tili wy�1��.�;�.���.'1�;4L��," ..'!. � I�� . I, R�I �� �n. �,�����,�.�� ..� I... .����II;IHy�i�i�rm���la����ll'���uilyld�Uh��vpUi�4l�iirvu II{
m��,�,��al.,�a�����e�m�����y�,���y���,�c.ael�wink�Ylnen,I����.�.TF„��..�.��.71...���,. I....... '��l..711n�,i�,I,`^I�LS 'I I�i � ���.�..�'!;'��I...I.. �,1 I.V I1 ep� I � 1 V ul�nbryr,h�i.i
Yhe undersigned hereby �pplies fo the City for issuance of a Plumbing Permit, agrees to do all work in
strict a�cordance with the ordinances of the City and the regulations of the State of Minnesota, and
certifies that all statements m�de on this application are complete, firue and correct.
ApplicanYs Signature: Date: �.� ��1� l�o
Building Official/ Inspector: Date:
Page 2