HomeMy WebLinkAbout2016-00693 - plumbing � � CITY OF ORONO * Z 0 1 6 - 0 0 6 9 3 *
, 2750 KELLEY PARKWAY DATE ISSUED: 06/16/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 4220 CHIPPEWA LA
PIN : 31-118-23-42-0012
LEGAL DESC : CHIPPEWA 2ND ADDN
: LOT 001 BLOCK 001
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURES-MULTIPLE
NOTE: NEW FIXTURES:5 WATER CLOSETS,7 LAVATORY,2 BATHTUB,3 SHOWERS, 1 KITCHEN SINK, 1 DISPOSAL, 1 DISHWASHER
2 SILLCOCKS, 1 FLOOR DRIANS, 1 LAUNDRY TRAY, 1 WASHER, 1 WATER HEATER, 1 WET BAR
VALUATION OF PLUMB[NG 17000
APPLICANT PLUMBING FIXTURE FEE 212.50
STATE SURCHARGE PLBG(VALUATION) 8.50
DIVERSIFIED PLUMBING TOTAL 221.00
P O BOX 91 Payment(s)
CHASKA, MN 55318- CHECK 5174 221.00
(763)221-5441
Minnesota State License#: PLUM-71354924
OWNER
DBG,LLC
SCHRODER, SUSAN
4725 WEST LANE
MINNETRISTA, MN 55364-
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
perniits. 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 I80 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 ime for�ue cause.
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Ap �cant Permitee Si n u Date Issued By Si nature Date
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�pN ., City of Orono FOR CITY USE ONLY
O � P.O. Box 66 Date Received: �I l� �/b
` � 2750 Kelley Parkway
'.,;� Crystal Bay, MN 55323 Permit# 7��(��C(� 3
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CITY OF ORONO — PLUMBING PERMIT ;,�
(All Commercial Permits Must be Approved by the State Prior to City Approval)
http://www.dli.mn.qav/CCLD/PDF/pe plumbplanrevapp.pdf
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 All That Apply)
x0 Residential ❑ Commercial (Approval Required) [Backflow Device: ❑AVB ❑PVB]
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 I Owner Information:
Site Address: 4zzo cx►PPEwA Ln�
OWtI@f: M&M HOME CONTRACTORS MaIIICIg AC�C�1"@SS: 413 PAUL AVE S
Clt�/: COLOGNE Zjp; 55322
Home Phone: 9sz-�9�-s�zo Alternate Phone:
Contractor Information:
COt1tr8CtOr: DIVERSIFIED PLUMBING COIItaCt PGfSOtI: COLLIN KING
Address: Po Box 9i Stat@ BOf1Cj #: 71354924
City: cHAs� Zlp: 55318 Expiration Date: o��oi�zoi�
PI1011@: 952-448-0756 AIt@C'Clat@ PI1011@: 952-334-2794
Q If1SU�aI1C2 — CU('t'@Clt: AMERICAN FAM[LY GENERAL LIABILITY 22-XG1686-05 WORK COMP 22-XG168690
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PLUMBING FIXTURES BEING INSTALLED
FIXTURE BSMT 1sr 2ND OTHER FIXTURE BSMT 1sT 2ND OTHER
TYPE Floor Floor TYPE Floor Floor
Water Closet 1 1 3 Floor Drains 1
Lavatory i 1 5 Sewer Ejector
Bathtub Z Laundry Tray 1
Shower 1 2 Washer 1
Kitchen Sink i Water Heater 1
Disposal 1 Water Softener
Dishwasher 1 Wet Bar 1
Silicocks 2 Miscellaneous
PERMIT FEE CALCULATION �� � ' `
1. CONTRACT PRICE " is 1.25% of contract price with a (Minimum Fee of$50.00)
$i�,000 x .0125 $ 212.50
(contract price) (minimum $50.00)
2. STATE SURCHARGE
$i�,000 x .0005 $ sso
(contract price)
3. POSTAGE � HANDLING (Only on Mail-In Applications) $ '.-�--
4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ 2zi.00
* 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.
PLUMBING 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 ma e on this appli ation are complete, true and correct.
Applicant's Signature: Date: 6/16/zoi6
Building Official/ Inspector: Date:
Page 2
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CITY OF ORONO CALLED IN ��
INSPECTION NOTICE ���,3 SCHEDULED � �
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