HomeMy WebLinkAbout2012-00833 - plumbing , CITY OF ORONO * 2 0 1 2 — 0 0 8 3 3 *
� 2750 KELLEY PARKWAY DATE ISSUED: 08/22/2012
ORONO, MN 55356—
� (952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1825 FAGERNESS POINT RD
PIN : 17-117-23-23-OO19
LEGAL DESC : MAPLEGATE INLET
: LOT 002 BLOCK 001
PERMIT TYPE : PLUMBING (<$500)
PROPERTY TYPE : RESIDENT[AL
CONSTRUCTION TYPE : WATER HEATER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
CHAMPION PLUMBING LLC STATE SURCHARGE PLBG (<$500) 5.00
3670 DODD ROAD- SUITE 100
EAGAN, MN 55123- MAIL-IN FEE 2.00
(� TOTA L 22.00
OWNER
BOZON[E, PAUL& PAMELA
1825 FAGERNESS PT RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming[his type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time aRer work has commenced.
The applicant is responsible for assuring all required inspec[ions are
requested in conformance with the State Building Code.7�his permit may be
revoked at any time for due cause.
��,c,L L2ti l l
' - � G�'��1���i l l
Applicant Permitee Signature Date Issued By ignature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A E.
� .
�g,��,o City of Orono
FOR CIT2'USE ONLY
I'.0.Bo�66 Date Received: Pennit#
27�0 Kelley Parkway
'' ' 7 � Ci�-stal Bay,MN 55323
' ' ; Approved By: Amount$:
.`"�k�xo�,�,�, (952)2-�9-�M1600—Main '
-..._. (9�2)249-3616—Fax
CI'�'�' Q�' �T�OI��— ��L�Jl@�8�� g��l�'���'
(Al I Commercial Perrnits l��ust be f4.p�roved by the Sta�e Prior to City Approval)
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GENERAL INFORMA,TION �'�```'��'�'��"•e�`��'�.�'u€
1. You ma��apply for p]umbing permits by mail or in person at the City offices. Applications will be
revie�ved and a permit wi]] be issued within two wo:king days.
2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT
VALID U1vTIL YOU RECEIVE A PERMIT. WQ�RF{1V�FiJST N�T BEGFN UNT�L'Y'�&�
PERIVFIT CA,Rfl pS POS7'ED�N TFt�JOB SITE.
3. Plumbin�perniits may be issued ONLY to licensed plumbing contractors and to property owners
,-esiding in ,I;e dwell;ng.
4• Wlieil 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 requirecf)
TYPE OF PERMIT
(Check All That A ly
�-Residential ❑Commercial(Approval Required)
� �Te�' ❑ Additional
❑ Repairs �Replace
❑ in Accessory Structure?
�You will need prior approval and may need CLP.(Per Orono City Code,Chapter 78,Article IV)
Job Site/O���ner Infonnation:
Site Address: � � �� � �
Owner:� l ��� Mailing Address: JC.I�'
c��: �►'�I�IU �al
Zip:
Home Phone: l � �l� 1�-�1J Alternate Phone:
Contractor lnfoematio�l:
Contractor: PC 000308 Contact Person: c
651-365-1340
Address: State Bond#:
c it : Eagan, M N 55L�23 � � - � �-
y lp: Expiration Date:
Phone: Alternate Phone:
❑ Insurance—Current:
]
�Jv
�« `�`
` PLUMBING FIXTURES BEING INSTALLED, �
FIXTURE BSMT 1 2'�D OTHER FIXTURE BSMT is 2 OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor D rains
Lavatory
Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal r oftener
Dishwasher Wet Bar
Sillcocks Miscellaneous
��� PERMIT��FEE CALCUL�T'ION(S)
BASED OFF-2002 STATE STATUE
� Yes,this section aUplies
/\
The replacement of only one Residential fia�ture or appliance that meets all three of the following
requirements:
1. Does not require modification to electrical or�as service.
2. Has a total cost of$�00.00 or less;excludinQ the cost of the fixture or appliance: and
3. Is improved, installed or replaced by the homeowner or licensed plumbin�contractor.
Sl:ip next section,ifthis applies; Cost ofPermit $ 15.00
State Surcharge $ 5.00
Mail-Tn Fea(If Applicable) $ 2.00
Total Permit Fee ��
(Fermit Fees Co�iti��sed Q�n 1�'e�t���e)
2
ie �
PERMIT FEE CALCULATION S -30BS OVER $�00.00
If above does not apply;follow guidelines below:
l. CON'�'kt,4.C�'PF�FCE �is l.25%of contract price with a(1@�Fireimum�'ee of�SO.OQ)
x.0125$
(contract price) (minimum 550.00)
2. S�F'/�TE SEIRCF�,�RG� **Add the State Bldg Code Div. Surcharge(I��Einimurn�'ee of�5.00)
x.0005 $
(contract price) (minimum S 5.00)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAl..,PEff2]O�IT F'EE(Add Lines 1-3 Above) �
° '� CONTRAC l PRtCE or JOB COST means the actual or estimated dollar amount charged for the
perniitted worl: including materials, labor,profit, and other fiaed costs. It is the amount to be charged
to the customer for the work done. If any material, equipment, labor or installations are fumished 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 tlle job cost, the City may request the submission of a sig�ed copy of the actual contract.
° *�The STATE SURCHARGE is .0005 of the contract price under$1,000,000 or$�.00—whichever is
�reater. For valuations over$1,000,000 call the Building Department at(952)249-4600 for the price.
PLUMBITiG PER1VtIT APPI,ICATION�GREEMENT
The undersigned hereby applies to the City for issuance of a Plumbing Pennit, 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.
� ' �J' _ /f� I �
Applicant's Sionature: J���Date: �� ��
, F�ese� F�E�a
3