HomeMy WebLinkAbout2004-P07556 - vacuum breaker � �
� PERMIT
C; TY OF ORONO Permit Number:
2750 Kelley Parkway - PO Box 66 Po�ss6
Crystal Bay, Minnesota 55323 Pe►'mit Type: Vacuum Breaker
(952) ?49-4600 Date Issued: 6ili2ooa
SITE ADDRESS: 1025 Heritage La
Wayzata,MN 55391
PID: 10-117-23-13-0008
DESCRIPTION:
Proposed Use: Kesidenhal
Permit Class: Plumbing
Permit Type: Vacuum Breaker Permit Sub-type(s): Vacuum Breaker
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 15.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
Misc. Fee: $ 1.50
TOTAL FEE: $ 17.00
APPLICANT: �'eld& Sons Plumbing OWNER: Dean Patterson
315 Juneau Lane 1025 Heritage La
Plymouth,MN 55447 Wayzata MN 55391
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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APPLICANT PERM[TEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Si�nitures Requirect), 1-Applicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
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CITY OF ORONO APPLICATION FOR PLIT1�iBING PERMIT
Box 66 (2750 Kelle,y Parkway)
Crystal Bay, NP1 55323
GENERAL Pi TF'OR.�LATION
1. You may apply for plumbing permits by mail or in person at the City o�ces.
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 UNTII. THE PERMIT CARD IS
POSTED ON THE JOB SITE.
3. Plumhing permits may be issued ONLY to licensed plumbing contractors and to property owners residing
in the dwelling.
4. When any new consuuction or remodeling is involved, a separate building permit must be obtained.
5. All work must be done in accordance with the State Code requiremen[s.
6. All work must be inspected and air tested before it is covered. Call 249-4600. 24-hour notice required.
Instructions Complete all items on this application. Compute the pemnit fee. Sign and date
the cert�cation. INCOMPLETE APPLICATIONS WII,L NOT BE PROCESSED. If you have
questions, call 249-4600.
Please check one: New � Addition Repair Replace
� Residential Commercial
JOB SITE: l'C3�.� ���`� ��=��r� Lc�,�G= Zip: �--�%�
Owner's Name: ���rG f��� r-r� S Telephone Number: y�-2_ y _���
l�Iailing Address: S��� City: Zip:
Contractor's Name: t��/J �.- So.,s P/�M�%�4 Telephone number: 7�.3-y'7.�-C�,Z��'
1�lailing Address: �j,� ,�`�,,�ti�. L.c,�n� City: ,�.��,�� Zip: .Ss 5r�/;�
,
PLUMBING FIXTURE SCHEDULE
FIXTURE BS�1T 1ST 2ND OTHER FIXTURE BS�1T 1ST 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory ' Sewer Ejector
Bathcub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Misc (list) I
1/c�c:vv ��►-� b,�-� �� ,��.-_ ;1��;-
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PERMIT I'EE CALCULATION j��° ���
1. 1.25% of Contract Price* or Minimum FeQ ($3�.00) � ``
x .0125 $ «�a
(con[ract pr.c�)
2. State Surchar�e. ** Add the State Buildina Code Division
Surcharge to each permit. � x .0005 $ ,-s�
(contract pr.�e)
or $.50, whichever is greater
3. PostaQe and Handlin� (Only mail-in appl:�ations) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �►: G7 �
* CONTRACT PRICE or JOB COST means the actuzl o:es[imated dollar amount charged for the permitted
work including materials, labor, profit, and other n�zd cosu. It is the amount to be charged to the
customer for the work done. If any material, equip�en:, labor, or installation are furnished by the owner,
!t'�a_R[ nr c1nV �1C�:rr n�_rty ihP r�?cOP.ahl� marl_ot y^__. Of SL'C}� ::?TL; WllS; }J� ����� :� } •: ° .
. . - ' - - :.u:, CS.,:u3ICu CG:i:
or contract price for permit fee purposes. In the eve�_ chat the�e is a dispute on the amount of the job cost,
the Ci�y may request che submission of a signed ce�;: of che actual contract.
** The STATE SURCHARGE is .0005 of the contra:.: price under 51,000,000 or $.50 - whichever is
greater. For valuations over �1,000,000 call the D=^artment of lnspectional Services for the price.
The undersigned hereby applies to the City for issu�rce of a Plumbin� Permit, a�rees to do all
work in strict accordance with the ordinances of t�.e City and the regulations of the State of
Minnesota, and cer[ifies that all statements made �� this application are complete, true and
correct.
Applicant's Signature: *�^^- i�G����a�— Date: —�'�`� /
✓ ,
plumb�^9 DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED �S"�`� 0 ��
PERMITNO. P �� COMPLETED � '�� ��•o�
ADDRESS ���'� ��'��`��� ��L
OWNER P �`��Su � CONTR. �e\� �- ���5
TELEPHONE NO.
� DESCRIPTION ���:������ S�1St t� �-��1
�
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINA� 19 LAKESHORE/WETLANDS
�
O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
J 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YE�NO
� COMMENTS: � �G���� �� �^�' D I<
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W� ❑WORK SATISFACTORY:PROCEED t�ROJECT COMPLETE
W ❑CORRECT WORK 8 PROCEED '- ISSUE CERTIFICATE OF OCCUPANCY
� ❑ Ct�FRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-46QQ
Owner/Contractor on site:
Inspector. �� '''m'��
White Copyllnspector's File Canary CopylSite Notice