HomeMy WebLinkAbout2012-00623 - plumbing . � ,
CITY OF ORONO * 2 0 1 2 - 0 0 6 2 3 *
2750 KELLEY PARKWAY DATE ISSUED: 06/29/2012
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3300 FOX ST
PIN : OS-117-23-44-0003
LEGAL DESC : REG. LAND SURVEY NO. 1358
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURES- MULTIPLE
NOTE: PLUMBING [�IXTURGS(1)EACH: KITCHEN SINK, DISPOSA[,AND D[SHWASHGR
VALUAT[ON OF PLUMB[NG 900
APPLICANT PLUMBING FIXTURE FEE 50.00
NOWTHEN PLUMBING STATE SURCHARGE PLBG (VALUATION) 0.45
19960 FERRET ST.
ELK RIVER, MN 55330 MAIL-IN FEE 2.00
(763)753-5216 TOTAL 52.45
PAID W[TH CC# 5814
OWNER
TRUBECK, W[LLIAM&JUDITH
3300 FOX ST
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time afrer work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conti�rmance with the State Building Code.This permit may be
revoke t any time for due cause.
, �� Z�� /� � 21� 12�
Applicant Permitee Signature Date Issu By ignature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
r@6/2$/2612 02:40 7637535125 NOWTHEN PLUMBING PAGE 02104
O CIT 'USG OVLY
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f����M �1 z750 KcII�Y�'arkway
4�i+� �lly��4'�,�,,. Crystul�3y,MN 55323 nrprav�Q Ry: Amnunt$:_
�$'"+S' fY�•�J (952)2d9-4600�-M�in
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CiTY OF ORONO ^PLUMBTNG PE.RMIT
(All Cominercial Pen�its Musl bc A�proved by tlae 5tate 1'rior to City Aphroval)
htt ://www.dli.mn. ov/ CLD/PDT/ e lu lanreva . d.f.
GENERnI. iNFORMATfON
I. Y'ou may a.pply for plumUing permits by mail or in person at thc City offices. Applications will bc
reviewcd a�d a permit will be issucd wichin two working days,
Z, pennit cards will be sent by retum mail after a ceview is comple[ed. PE.RMITS ARE NOT
VALID UNTIL YOU RECEIVE A,PERMiT, WORK MUST NOT I3�GIN CI T1L THE
PF'RMIT_'ARD IS POSTED ON T C,10B SITE.
3, Plum�ing pennits may be issued ONLY to licensed plumbing eontractors and to property owners
residing in the dwelling.
4. Whcn any ncw constniction or remodeling is involved,a separale building permit tnust bc
obtained.
5. All work must be done in sccordance with Staee Cade requireinencs.
6. All work must be inspected and Air cested before it is covered, Coll(952)249-460t1.
(24-48 hour notice rcquired)
TYPC OF PER.MIT
Check/�II That A I
d Rcsidantial ❑ Commarcisl (Approval Ftequircd)
❑ Ncw ❑ Additional ❑ Rcpairs ❑Replacc
❑ In Acccssary Structure?
"`You ill need ' r a ro� 1 and may need CU�.,(Per Orono City Code,Chapter 78,Article IV)
Job Site/Owner lnformation:
��r� Adar�SG: 3300 Fox Street, Long Lake
Owncr:B�II TrLIL�ECIL �a;�;,,s ada,-ess: 3300 Fox Street
c�ty: Long Lake Z;p:
F-lomc Ph�ne: Altei7�atc Phane:
Contraclor lnformation:
Nowthen Plumbing, Inc Tammy
Contractor Contacc PcrSon:
19960 Ferret Stree4 NW PC,��422�
�\ddress: 5tate Bond#;
c�t Elk River Z�p:55330 rxpiralion Date: 12/31/12
Y=
I'hone: (763� 753-�3216 q��ernate Phonc:
� Owners Insurance Co
Insurance�Ctirrent:
1
66/28/2012 02:40 7637535125 NOWTHEN PLUMBING PAGE 03/04
r . �
PLUMBING F17CTURE5 BEtNG INSTA�.LED
FIXTURE BSMT I• 2 " OTHER FIXTURC BSM'1� 1' : ' OrHER
TYPE FL FL TYPE �L `��
Wt�ter Closet Floor Drains
1_,s►vatory Scwer E,jcctor
Bathtub Laundry Tray
Shower Waslter
Kitchen Sink ,� W2ter Hcfl�er
pisposal ,� Watcr$oftcner
Dishwa5her ,� Wet 8�►r
Sillcook.S Miscellancous
PERMIT FEE CALCUL�TiON(S)
BASCD OFF -2002 STATL• ST�TUE
❑ Yes,this section Applies
Tha replacement oi�only one Residenti�l fixture o liancc that mcel:s all thrce oFth� 1'oll�wing
rcquirements:
J, f)oes no�.r'equire modificatiun to elcctrical or g�s servic�.
Z, Has T lota.l cost of$500,00 0�less; exc din the cost oFthe fixturc or appliance: and
3. IS improved, ins[�Iled or replacad by lhe homeowneror Ilcenscd plumhing cvntrlctor.
Skip nexc scctic�n, i f this applies; Cost of PeiTnit � �5•��
5tate Surch�rge ���
Mt�il-In F�r(IFApplicable) � ?•��
Tocal Permit Fce $
(Perrnit Fces Continucd On Next P�ge}
2
061�8/2612 62: 40 7637535125 NOWTHEN PLUMBING PAGE 04/04
PERMIT FEE CA�LCULATTON S -JOBS OVER$500.00
If above does not Hpply; follow guidelincs helow:
1. NTRACT PR1C * is 1.25%of contract price wieh a(Minimum Fee of�SO.OQ)
9oo.ao X .0�25$ �� .25 _
(contracl pricc) (minimum t�50.00)
2. STATE SURCFIARGE OJOd.00 x.0005 �O.A� 'r3
(Cpnaaot pricc)
3. pQS'ThGC&HANnLING(Only on Mail-In Applications) ��_ -
$50.50
4. TOTAL PERMIT FEE(ndd Gines I-3 Abovr)
■ ' CONTRACT PR1CC or JOB CC)ST mcflns thc Actual or estimated dollar amo►mt chai�ed for the
permitted work including materials, labor, profit, and other fixed co�ts. ll is the amount to be cha.rged
to the customer far thc work done. Tf�.ny mat�rial, cquipment, labor or install��ions are furnished by
thc owner,tcnant or any othcr party,the reasonahle market va.lue of such itcros must be add�d to thc
�stiinated cost or contract price For permit fee purposes. ln thc event that clierc is a dispute on tha
amount of the job cast, Che City may request the suhmission of a si�ned copy of the a�tual contr�ct_
PI�UMEING PERMIT APPLjCATiON AGREEMENT
The undersigned hereby applies co the Cicy for issuance af a Plumbinb Pcrmit, agrees to do all
wprk in strict acc�rdance with the �rdinanees of the City flnd the regula.cions oP the State �fi
Minnesot�. and certifi�s that all statements made on this application are complete, trtie and
corrcct.
�pplicant's Signature: .
�att: �6128/12
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