HomeMy WebLinkAbout2016-00728 - plumbing CITY OF ORONO * z 0 1 6 — 0 0 7 z 8 *
. 2750 KELLEY PARKWAY DATE ISSUED: 06/23/2016
ORONO, MN 55356-
' (952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1885 CONCORD[A ST
PIIV : 17-117-23-23-0002
LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURES-MULTIPLE
NOTE: NEW:6 WATER CLOSETS,7 LAVATORY,2 BATHTUB,4 SHOWERS, 1 KITCHEN SINK, 1 DISPOSAL, 1 DISHWASHER,3
SILLCOCKS,
5 FLOOR DRAINS, 1 LAUNDRY TRAY,2 WASHERS, 1 WATER HEATER, 1 WET BAR,5 MISCELLANEOUS
VALUATION OF PLUMBING 45785
APPLICANT PLUMBING FIXTURE FEE 572.31
STATE SURCHARGE PLBG(VALUATION) 22.89
STEWART PLUMBING, 1NC. MAIL-IN FEE 2.00
13025 GEORGE WEBER DR
SUITE#1 TOTAL 597.20
ROGERS, MN 55374 Payment(s)
(763)428-1833 CREDIT CARD 3122 597.20
Minnesota State License#:plbg-PC000474,mech-MB003262
OWNER
KAISER,BERNARD&CAROLYN
2855 PROVIDENCE PLACE
INDEPENDENCE, MN 55359-
AGREEMENT AIYD 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 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 time for due cause. ��
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Applicant Permitee Signature Date Issued By Signature Dat ��
� �(}N , City of Orona FOR CI1Y USE ONLY
O `, P.o.Box ss Date Received: �� ��2-Z I I lf�
� 2750 Kelley Parkway .-� � .-�
���' � � � Crystal Bay, MN 55323 Permit# y---V � �r^ �"( �- (� �
`�F�1k� . (952)249-4600-Main ApPfOVed By: -�--�� ��
���+�� � `�� (952)249-4616-Fax � ��
Amount$: I JG � J .
CITY OF ORONQ — PLUMBING PERMIT
(All Commercial Permits Must be Appraved by the State Prior to City Approval}
S�ttt�Jfwww.c�ii.r�ar�.c�erv/C��.�SEF��FI�se �4umb I�_a_,s�revapp.�pdf
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City affices. Applications will be
reviewed and a permit will be issued within two working days.
2. Permit cards will be sent by return mail after a review is eompleted. PERMITS ARE NOT VALID
UNTIL YOU RECEIVE A PERMIT. WORK MUST IVOT BEGIN UNTIL THE PERMIT CARD IS
POSTED ON THE J�B SITE.
3. Plumbing permits may be issued (�N�Y to licensed plumbing contractors and to property owners
residing in the dwelling.
4. When any new construction or remodeling is involved, a separate building permit must be obtained.
5. Ail work must be done in accordance with State Code requirements.
6. All work must be inspected and air tested before it is covered. Call (952}249-4600.
(24-4$ hour notice required)
TYPE UF PERMIT(Check All That Apply) �
�Residential ❑ Commercial (Approval Required) [Backtlow De�ice: 0 AVB ❑ PVB]
(�New ❑ Additional ❑ Repairs ❑ Replace
( �
❑ In Accessory Structure?
*You will need p�ior approval and may need CUP. (Per Orono City Code, Chapter 78, Article IV)
Job Site / Owner Information:
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Site Address: � �%��'� ��!t���%�r��a ��1
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phane:
. -----___.
�__Contractor Information:
_-----___._-------
�- , -�
Contractor: � ����`'�� �� ��� �-{ ,Contact Person: ��.�.��`�.������
Address: .� ,� '�.�'=lT� �� �� �i`� � G'�i ��tate Bond #: �����
�,��`�EX r�L.��
City: � � 1�� Zip: �� piration Date: ' '�
Phone: � � �-��"���� Alternate Phone:
�Insurance—CurrenC: �����������
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Page 1
[� PLUMBING FIXTURES BEING INSTALLED �
FIXTURE BSMT 1sr 2ND pTHER FIXTURE BSMT 1sr 2ND pTNER
TYPE Floor Floar TYPE Floor Floor
Water Cioset �.� ,� ;� Fioor Drains �
Lavatory � �� ,� Sewer Ejector �
Bathtub ' � �aundry Tray
Shower ;� '� Washer � �
Kitchen Sink i Water Heater �
� Disposal � Water Softener �
Dishwasher 1 Wet Bar �
Sillcocks � Miscellaneous
PERMIT FEE CALCULATION � �
1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.U0)
����~), ��,7��f ���% x .0125 $ �� / ��i. ��
' (contract price) (minimum $50.00)
2. STATE SURCHARGE
' ��, �`�
� �, ��;�',1� U�`i x .0005 $
(contract price)
3. POSTAGE 8� HANDLING {Only on Mal-in Applications} $ 2.00 ,��
�� �� � .
4. TOTAL PERMIT FEE (Add Lines 1-3 Above} $ �j�� -�, �� �, '�
:
* CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
permitted work including materials, labor, profit, and vther 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 #hat 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 regulatians of the State of Minnesota, and
certifies that all statements made on this application are comple#e, true and correct.
Applicant's Signature• ���✓����J ' . ��-�� Date: ����� �tli
�
Building Official/ Inspector: Date:
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