HomeMy WebLinkAbout2015-01292 - plumbing CITY OF ORONO * 2 0 1 5 - 0 1 2 9 2 *
, 2750 KELLEY PARKWAY DATE ISSUED: 10/06/2015
� � ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 960 FERNDALE RD W
PIN : 02-117-23-44-0017
LEGAL DESC : COUNTRY CLUB ESTATES
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : VACUUM BREAKER
NOTE: ADD A VACUUM BREAKER FOR LAWN [RRIGATION
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
STATE SURCHARGE PLBG(<$500) 1.00
B& D PLUMB[NG&HEATING INC. MAIL-IN FEE 2.00
4145 MACKENZIE CT NE
ST MICHAEL, MN 55376- TOTAL 18.00
(763)497-2290 Payment(s)
CREDIT CARD 8094 18.00
OWNER
BROOKS,JOHN&JOAN
960 FERNDALE RD W
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 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 Signatu e Date Issued By Signature Date
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�k �"°`F�i{oµ�:,� (AI!Coinmercial Permits D1ast be Approved bp the State Prior ro Ci�y Appm�al}
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��GENERAL 1NFOR;V1A7I0\
� 1. �'ou may Tpply for plumbing pertnits by mail ur in person at thc City of�iccs. Applicetions��ill be
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• rzvie�ved and a permit w•ill be issued within iwo working dxys.
� 2. Permit cards will be sent by return mail after a review is completed. PER�IITS ARE t�OT
� V.ALID IINTIL YOU RECLIVE.4 PERM]T. w'ORK 111UST KOT DEGIN UA77L TIIC
� PF:RI411T CARD I8 YOS"1'ED ON'f'H�JOB SCI'E. �
0 3. Plumbing peimitc may be issued UNLY'to licensed plumbing coutrac[oi�and to property o�ti�ners
cv residing i�i�he dtve�ling.
�. W hzt4 any neu•cnnstruction or remodeling is iu�rolred,a separate building perniit must be
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p obMioul.
5, All�sork nu�st be done in accnrdmict u9th State Code requirements.
� 6. All work musc be ii�spccled wid air tesled beforc ii is covcred. CaEI(952)219-�1i00.
(24-J8 hour�rotice reqnireci)
'i YPL Ol YLRM11' �
(Chzcic Alf That Apply)
�Kesidential ❑Commercf�l(.Approval Required)
�.New ❑Additional ❑Repairs ❑Replace
❑ In Accessory Saucture?
*You will aced nrinr ayproval and niay oeed CUY.IP�r Orono Ciry Code,Chapcer 78,Article IV)
L3ob Site!Uwnzr Informalion ��
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Contractor lnformation:
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Contrucfir: �jt�l '��k',i;���� �', f1��I,,Ci��'ContactPerson: '";✓�� '��i :ssiY��:��
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'x 1 Yes,Ihis seclion appiies .
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Thr repEa�;ement of unly one 2esidential fix�ure or anollaqce tltai mteis all three of�he following
reyuirements: .
1. Dces not require modification to elzcaical or gas service.
�. I las a total ws[oi$�00.00 or less;excluding the cost of�he fixture or appGancer snd
�. Is improved,installed or re�faced by the homeowner or ficensed plambing co��lractor. _
Skip ner[sectinn,if diis applier, Cost of Pzrntit $ 15.00 - �
StateSuriiorez S i.(ID
�blail-In Fec(Ifi Applicable) S 2.00
'Cotal Permii Fee S
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� If abnve does��ot apply;follow guidelines belew:
� I. CON7 RACT PR10E `fs I.25°ro of conirnct pnce wi�h a(A'Iinimum Fee of 550.00)
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�`���'�� xA125$
_��—�—{cnnrat[pnoe) (minimnm cSU.W)
p 2. ST.4TE SCRCHARGE
° X.00as $
o (comrc�pnce) .
� 3. POSTAGE K HAVDWNG(Oniy un.Liail-ln Applicatiuns) S 2 00
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N 4. TOTAL PER1111T FEE(.Add Lines 1-3 Abova) $
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� " COl�T12ACT PRICE or JOB COST means�he actuai or estimated dollar amount charged for che
ppermitted work including materials,labor,profit,and other fixed costs. It is the amount�o be charged
r W thc cusiomer for the work dona If any msterial,equipment,labor or installations are furnished by
the ow�ner,tenant or any other party,[he reasonable market valuc of such i[ems mus[be added to the .,
estimated cost or comract price for penui[fee purposes. In che eveN ihat there is a dispu�e on the
amount of the job cost,the City i��ay request t3�e submisainn nf a signed copy of the actual conlra,t,
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The undersigned hereby applies to the City for issuance of a Plumbing Pcrmit,agrees to do all
x�ork in strict ac¢ordance with tt�e ordinancas of the Cfty aiid the regulatioris o1'tlte State o1�
Minnesota, flnd certifies [hnt 91I stnte�nents made on this applicatiun are comple€e, [rue xnd
CorrecL
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Applic<1nr's_ignamre: � ����'�����Y✓L/ D�te: �V� u:: �'r')
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