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Home My WebLink About2012-00912 - plumbing t 1 � CITY OF ORONO * 2 0 1 2 — PJ fd 9 1 2 * 2750 KELLEY PARKWAY DATE ISSUEU: 09/12/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3340 GRAHAM HILL RD PIN : OS-117-23-11-OO12 LEGAL DESC : GRAHAM HILL PRESERVE 2 : LOT 4 BLOCK 2 NERMIT TYPE : PLUMBING (<$500) PROPERTY TYPE : RESIDENTiAL CONSTRUCTION TYPE : FIXTURE NO"I�L: WA"I�I?R SOFTEN[?R APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00 RICHARD'S CUSTOM WATER STATE SURCHARGE PLBG (<$500) 5.00 6121 EXCELSIOR BLVD. #206 ST. LOUIS PARK, MN 55416- TOTAL 20.00 (952)920-1200 Minnesota State License#: WM061456 OWNER MCCARTY, LEROY& LISA 3340 GRAHAM HILL ROAD LONG LAKE, MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this permit is issucd shall bc performed accordine to the approved plans and specitications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate pennits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified hercin.This permit will e�pire and become null and void if construction authorized is not commenced wi[hin 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is re onsible for assuring all required inspections are requested in co mance with the State Building Code.This permit may be revoked at ime fo c ca �l i2/ �2 ��-�. � �l/ 2--//y. plicant P i Signature Date Issued Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. i` • ♦� G� / F R CITY USE ONLY ' A� Cit�-of Orono / / � /�4O`r P.O.Box 66 Date ceiv :`� Permit# �� 1�� I 2750 Kelley Parkway �7 � �� ,��'�;�'�"_ F Crystal Bay,MN 55323 Approved By: Amount$: e��'U ��r��xr�.�o` (952)249-4600—Main rexo$ (952)249-4616—Fax CITY OF ORONO — PLUMBING PERMIT (All Commercial Permits Must be Approved by the State Prior to City Approval) htt�://ww�i�.dli.mn.<tov/CCLD/PI)F/ e lumb tanreva �. df' GENERAL 1NFORMATION 1. You may apply for plumbing pernuts by mail or in person at the City offices. Applications will be reviewed and a permit will be issued within two working days. 2. Permit cards will be sent by retum mail after a review is completed. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3. Plumbing pernuts may be issued ONLY to licensed plumbing contractors and to property owners residing in the dwelling. 4. When any new construction or remodeling is involved, a separate building pernut must be obtained. 5. All wark 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 required) TYPE OF PERMIT (Check All That A ly) �Residential ❑ Commercial(Approval Required) 0 New ❑Additional ❑ Repairs ❑Replace ❑ In Accessory Structure? *You will need prior aAproval and may need CUP. (Per Orono City Code,Chapter 78,Article IV) Job Site / Owner Information: Site Address: � � � D �/'v�J�� lY� !�I L L '"'� Owner: �G�� 1��-1Yf�i� Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Informatio�i: Contractor: �L�,f�1i9�� '/'� jContact Person: Address: �� L?x�L's�Ul��S�Bond#: City: /`��/L�L� Zip�y� Expiration Date: Phone: 9��Z �Zv'�Z� Alternate Phone: ❑ Insurance—Current: 1 `• • `\ f ' � ' '' PLUMBING FIXTURES BEING INSTALLED � � FIXTURE BSMT 1' 2' OTHER FIXTURE BSMT 1 2' � OTHER TYPE FL FL TYPE FL FL Water Closet Fioor Drains Lavatory Sewer Ejector Bathtub Laundry Tray Shower W asher Kitchen Sink Water Heater Disposal Water Softener Dishwasher Wet Bar Sillcocks Miscellaneous � PERMIT FEE CALCULATION(S) ', � BASED OFF - 2002 STATE STATUE I ❑ Yes, this section applies ' The replacement of only one Residential fixture or appliance that meets all three of the fol,lowing requirements 1. Does not require modification to electrical or gas service. 2 Has a total cost of$500.00 or less; excludin�the cost of the fixture or appliance: and 3. Is improved, installed or replaced by the homeowner or licensed plumbing contractor. Skip next section, if this applies; Cost of Permit $ 15.00 State Surcharge $ 5.00 Mail-In Fee(If Applicable) $ 2.00 . Total Permit Fee , $ • . A (Permit Fees Continued On Next Page) 2 �/, � , � �� PERMIT FEE CALCULATION(S)�-J4BS OVER$500.00 � � If above does not apply; follow guidelines below: 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) � gD , � h .oi2s $ (contract price) (minimum$50.00) 2. STATE SURCHARGE x .0005 $ (contract price) 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted work including materials, labor,profit, and other fixed 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 the job cost, the City may request the submission of a signed copy of the actual contract. '' ��#k' .` B�G PERMIT APPLICATION AGREEM��T�;��,� �;` y��. �� : , �. , � . The undersigned hereby applies to the City for issuance of a Plumbing Permit, 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. . Applicant's Signature: Date: �� f � 3