HomeMy WebLinkAbout2015-00820 - water softner �' CITY OF ORONO
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. 2750 KELLEY PARKWAY DATE ISSUED: 06/24/2015
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 565 FERNDALE RD N
PIN : 36-118-23-14-0004
LEGAL DESC : UNPLATTED 36 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMB[NG (<$500)
PROPERTY TYPE : RES[DENT[AL
CONSTRUCT�ON TYPE : WATER SOFTNER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
STATE SURCHARGE PLBG(<$500) 5.00
CULLIGAN SOFT WATER SERV[CE CO. MAIL-[N FEE 2.00
6030 CULLIGAN WAY
MINNETONKA, MN 55345- TOTAL 22.00
(952)912-7379 Payment(s)
CRED[T CARD 8645 22.00
OWNER
LETEUNE,CNARLIE
565 FERNDALE RD N
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. Ali provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause. �
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Applicant Permitee Signature Date Issued By Signature Date
0�/2�/2015 14:09 FaX 952�3a5049 CL�LLIGAN MNTItA C�002
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� I'OR CITY US�ONT.Y
t'Q'� ' City of Oronu r ,
f�� ���� P.O.Tiox 66 Date Rcceived:ll 2 (�5 Permit# ��I 5 �
h �p„ � 2750 Kelley Parkway .
I'a � i�,;�i- �I Cryscal 8ay,MN 55323 .4ppro��ed By� �Amount$:
`��.�� (952)249-460Q
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crT�o�o�oNa-��.�rmc�az�vc P��Mz�
(All Commercial pennirs must be approved hy the Building O�ci„�o�f��speC�o�)
�E�Ra.r,m�ox�Tlo�v
1. You may apply for plumbing permiu by mail or in person sl the City offices. Applications will be
rcvicwod and a permit will be issued within two Worhins days.
2. Permit caYds will b�scnt by rcturn mail aft�r a review is completed_ PERMITS ARE NOT
VALTI7 TJN7'IL YOU RECEIVE A PERMIT. WORK MUST NOT SEGP.V UNTIL TRE
PERMIT C.4}tn IS�'OST�A 0:1'Z'HE J�B SITE.
3. Plumbing permits may be issued ONLY to licensed plumbing cantractors and to property owners
residing in the dwelling.
4. When any new construetion or remodelin�is involv�d,a scparate building permit must be
obtained.
5. All work m¢st be done in a�cordance with State Code iequi�ements.
6. All work must be inspectcd and air tcsted beforc it is covered. Call (952)249-4600.
(2448 hour noticc required)
T���a�p��7-r
Ch�ck A11 That A 1
�Residential ❑Commercial(Approval�Zequired)
�New ❑Additional ❑Rcpairs ❑Replace
❑ In Accessory Structure?
*You will need nrior appro��fl�and may need CUP.(Per Orpnp City Code,Chapter 78, Article f V)
Job Site/�w�ner Information:
Site Address: J��s �'��n�G-� �� 'v
Owner: �4r�i� ���k�A Mailing Address:
Citiy: zip: ���Q �
Home Phone: ��� ��1� �� �50°� Alternate Phone:
Contractor�n�ormation:
Contractor: Contact Person:
CUf���1 WATER G4hfDITJONING State Sond#:
603o CU
� INf�ETalVKA, MN 5534�
. � `��2} _ ip: Expiration Date:
>�,� ,
Phone: Alternate Phane: 9'5d- �I -'l ►
❑ Insurance—Current:
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06i2a/2015 14:09 FA?i 95293a5049 CtiLLIGAN 17NTRA �J003
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� HER FIXTURE SSMT 1 � 2 �� OTHER
�'IXTURE BSAQT 1 � OT
"TYPE FL PL TYPE FL FL
Water Closct Floor Drains
Lavatory Sewer Ejeccor
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Batl,tuB Laundry Tray i
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Shpwer W ashcr
Kitchen Sink 'Water Heater
Disposal Waier Softener 1
Aish.vasher � Wet Bar ;
SiIICOCI:s Nilscellaneous '
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Q 1'es,this section applies
The replaccmcnt of d Resident'ial fixture or aDA���ce that mects all thrcc of the Collowing requlrements:
1. Does not require modification to electrieal or gas service.
2. Has a total cast of$500_0o or]ess;cxe3udin�the cost of the fi�ture or appliance: and
3. rs improved,installed or rcplacod by the homeowi�e�or licensed contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
Stat�Surcharge $ 5.00
Mail-In Fee(If Applicablc) � 2.00
Tatal Permit Fee $
(Pcrmit Fees Continued On Next PAge)
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06/2�%2015._14:0� FA� �52�a�504� CULLIGA� MNTK� C�004
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, . If above does not apply;follow guidelines below: s •
1. CONTRA,CT P�r�� *is 1.25°�0 of contract price with a(1VIinitnum Fee of 550.00)
x.0125$
(�onmau price) (minimum��O,00}
2. STAT�SURCH.ARG� **/�dd U1e STate�idg Codc Div. 5urcharg�(Minimum Fce of 55.00)
x .0005 $
(conasc[price) (minimum� 5.00)
3. POSTAGE&HANb�,7]�1G(Only on Maal-In Applications) � 2_00 _
4. TO'�'AT�PER�F'IjT FEE(Add Lincs 1-3 Above) $ a-�-��
■ * CONTRACT PRICE or 30B COST means the actual or estimated dollar Amount charged foC ihe
permitted worlc including materials, labor,proft,and other fixed coSSs. It is the amount to be charged
to Lhe customer for the work done. If any m�terial, equipment, labor or installations are fumishcd by
the owner,tcnant or any other party, the reasonab]e market�alue of such items must be addcd to ihe
estimated cos[ or contract pricc for pe�rnit fee purposes. Yn the event thst there is a dispute on the
amount of the job cos�thc City may request the submission of a signed copy of tho aetual contract.
� �**The S7'A7'E SURCHARGr�is_0005 of the contract pricc undet$1,000,000 or$5.00—whichever is
greater. For valuations over 51,000,000 eall the�uilding Department at(952)249-4600 for the,pricc.
rhs'��� .'t^U� ��4 ° � � i n r �. �,..�,����iPA�''M ki,r��.
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,?��,�����,A>,".�pr�,rd,��,��;'.,fz�?'�'F��� ! �i�'��'P�APPLIG�,��; 'Ca��.�GREEN'1�N�t:,.,-,�wa;� ��,��.�, ,,��-.
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 regu]Ations of the Siate of
Minnesota, and cenifies that a11 statements made on this application are complete, true and
correct.
Applicant's Signature: - pate: �b - �-� - f
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CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED
PERMR NO.�0�5 -Uo $� COMPLETED �i ��6 •/�
�eEss sbs �'��K��<< 2��a�,
O'WNER TELEPHONE NO.
CONTRACTOR �
� DESCRIPTION �jmt�.� ��6n�v ��s���l•
ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GHADING/FILLING
�Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
� ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑WOOD BURNERIFIREPLACE ❑ COMPLAINT
`� ❑ WATER HOOK-UP �FOLLOW-UP
W AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATIONlREMOVAL
_
v ❑ DEMO-SITE ❑ SEPTIC INSTALL
Z dINN6VCONTAACTOR TO MEET YWh_YES_NQ
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j Permit has expired per MN Building Code Sec. 1300.120 subp. 11
� Expiration, no record of a Final inspection.
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W ❑WOFIK SATISFACTORY:PROCEED O PFiWECT COMPLETE
� O CORRECT WORK 8 PROCEED O ISSUE CERTIFICIITE OF Ot�CUPANCY
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0 O CORRECTVMORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERtNO PERMANENT
❑CORRECT UNSAFE CONDfT10N WITHIN HOURS. p pHpTOUKEN
INSPECTOR WILL RETURN
O STOP ORDER POSTED.C�ALL INSPECTOR ❑aTATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRAN(iE ACCESS.
caN ror u�e next tispe�tto�2�►nours�a�►anos. (952) 249-4600
on sRe:
Mspector: G�i�r- ��
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