HomeMy WebLinkAbout2003-P07094 - water softner CITY F ORONO PERMIT
� Permit Number:
275Q��Iley Parkway - PO Box 66 P07094
Crystal Bay, Minnesota 55323 Permit Type: Fixcu�es
(952) 249-4600 Date Issued: i2�i2�2oo3
SITE ADDi�ESS: 4475 Forest Lake Landing
MOUND,MN 55364
PID: 07-117-23-24-0023
DESCRIPTION:
Proposed Use: Kesidential
Perniit Class: Plumbing
Permit Type: Fixtures Permit Sub-type(s): Water Softner
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
FEE SUMMARY: PermitFee: $ 15.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
Misc. Fee: $ 1.50
TOTAL FEE: $ 17.00
APPLICANT: Culligan Soft Water Service Co. QWNER: JON&GAIL BLACKSTONE
6030 Culligan Way 4475 FOREST LAKE LANDING
Minnetonka,MN 55345 MOLTND,MN 55364
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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--�C/�C�
nPPLICANT PERMITEE SIGNATURE ISSUED BY SIGNA"CURG
Cooies: 1-File(Signitures Required), 1-Applicant, 1-Monthlv Reports. 1-Assessine, 1-Finance Page 1
CTT'Y OF 0170N0 APPLICATION FOR PLUIVIBTN'G PERNIIT
Bo�c 66 (2750 KeIley Parkway)
Cr�stal Bay, 1VIN 55323
(;F�VE�tATr INFORMATTOI�I
I. ^ Yoa may apply for plumbing permiu by mail or in petson at�he City offices.
2. Permit cards will be sent by recurn mail after a review is completed. P�I2MITS ARE NOT VALT�UNTIL
YOU REC�IVE A T'$�2MIT. V✓0�2K_MUST NOT AEGIN iNTIL THF PERMiT CARD 1S pOSTED ON
TH�70B STTF_
3. Plumbing pecmits may be issued ONLY to licensed plumbing conuactors and to property owners residi.nb
in the dwelling.
4, When any new construction or remodeling is��nvolved, a separa[e building permit musc be obtai.ned.
5. All work must be done in accordance wi�h the: Stau Code requiremen[s.
6. A.11 work must be inspected and air tested 1�efore it is covered. Call (952) 249-4600. 24-hour norice
required.
Instruc�ic►ns Complete all items on this application. Compute the permit fee. Sign and date the
certification. INCOVIPLETE APPLICATTUNS WILL NOT BE PROCESSED. If you have
questions, call (952) 249-4600.
Please check one: New _ Addi[ion Repair �2eplace
Residential Commercial
JOB SITE: �-,��17 7 �vr'� �}- �,��� L�1�i�l�.�c. Zip:
Owner's Name: - I k.�� .��-� Teiephone Number: ��:� -y��,?-�z;z �`
Mailing Address: City: Zip:
Contractor'sName: CULLIGAi�! WATER CONDITiONINC�elephoneNumber:
Mailing Address: 6030 �1 City: ZYp:
, �
PLY��U��:rU K N: SCT�EDULE
FIXTLTR� BSMT 1ST ZND OTH]:R �T�'YTURE BSMT 1ST 2ND OTHER -
-FypE FL FL TYP� FL PL
'Water Closet F1oor Drains
Lavato Sewer �iector
Ba[htub Laundrv Tra
Shower VVasher '
Ttitchen Sin�: Water Hea�er . (
Dis osal Water Softener
Dishwasher wzt�ar
Sillcocls Misc(Iist)
PERMYT �E CALCULATYON(Sl � .
20 2 State Statute Yes, This Section Applies
The replacement of a Residential f xture or appliance that meets all three of the following
requirements_ •
1) Does not require modification t.o electrical or aas service.
2) Has a total cosc of$SOO.OQ or less; excludinQ the cost of the fixture or appliance:
and
3) Is impraved, installed or replac ecl by the hameowner or lice ed contractor.
Skip next secuon; Cost of Permi $ T5.00
� State Surchar e $ .SO
Mail Yn �ee $ 1.50
.dD
If above does not apply, follow guidelines below:
1. Contract price* is .�125 % of job with a 1�Iinimum Fee of ($35.Q0)
x .0125 $ j �� ��
(contr;ict price) (minimum$35.00)
2. State �urcharge. *�` Add the State Building Code Division a (IVlinimum �'ee of $ .50)
X .QQQ� � `� � .
(cona•act price) (minimum$ .50)
3, Posta�e and Handling (pnly mail-in applicarions) $ 1_50
4. TOTAT. PER'�IIT F�E (Add lines 1-3 above) $ ��, L� �
* CONTF.ACT PRICE or 10B COST means thE:actual or estima�ed dollar amoun�charged for the permitted
work including materiais, labor,profic, and od�er fixed costs. It is che amoun�to be charged to the customer
for the work done. If any material, equipmec�t, labor, or installation are furnished by the owner,tenanc or
any other party the reasonable market value cf such i[ems musc be added to the estimated cost or contrae�
� price for permi[fee purposes. In the avent thac there is a dispute on che amount of the job cost, the Ciry may
request the submission of a signed copy of thc actual contracc.
** The STAT�SURCHARG�is .0005 of the coi�tracc price under S1,OOQ,000 or S.50 -whichever is greacer.
For valuations ovcr�1,000,000 call the Depacanen�of Inspectioa Services for the price. ,
The undersigned hereby applies to the City f��r issuance of a Plumbing Permit, agrees to do all
work in strict accordance with the ordinanc�:s of the City and the regulations of the Scate of
Minnesota, and certifies that all statements made on this application aze complete, ttve and
correct.
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Applicant's Signature; ' jr ----� Date: i� Z�/�d�3