HomeMy WebLinkAbout2003-P06490 - vacuum breaker CITY OF ORONO PERMIT
2750 Kelley Parkway- PO Box 66 Permit Number: Po6a90
C��stal Bay, Minnesota 55323 Permit Type: vacuumBreaker
(952) 249-4600 Date Issued: ��i�2oo3
SITE ADDRESS: 1100 Heritage La
Wayzata,MN 55391
PID: io-ii�-23-i3-000s
DESCRIPTION:
Proposed Use: xesidential
Pemut Class: Plumbing
Permit Type: Vacuum Breaker Permit Sub-type(s): Vacuum Breaker
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
Vacuum Breaker
FEE SUMMARY: PermitFee: $ 15.00 Valuation: $ 325.00
State Surcharge Fee: $ 0.50
Misc.Fee: $ 1.50
TOTAL FEE: $ 17.00
APPLICANT: Weld&Sons Plumbing OWNER: Kurt Retzler
315 Juneau Lane 1100 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 PERMITEE SIGNATURE SSUED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Applicant, 1-Monthlv Reroorts, 1-Assessine, 1-Finance Page 1
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CITY OF ORONO APPLICATION FOR PLUMBING PERMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
GENERAL INFORMATION
1. You may apply for plumbing pemuts by mail or in person at the City offices.
2. Permit cards will be sent by return 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 pemuts 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 work must be done in accordance with the State Code requirements.
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 permit fee. Sign and date
the certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have
questions, call 249-4600.
Please check one: New � Addition Repair Replace
� C� Residential Commercial
JOB SITE: ���� /T�r"� ��--�� L�..�'� � Zip:
Owner's Name: �'v��- ���yl�_r— Telephone Number:
Mailing Address: S�.-•-y, � City: Zip:
Contractor's Name: �/� ¢– �-h s Pl��b��-�q Telephone Number: �63-�7-s"-azy6
Mailing Address: 3i,5" Svnea�� Z�:��e City: j'/y���,�� Zip: SSyy;7
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PLUMBING FIXTURE SCHEDULE
FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Misc (list) �
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PERMI TEF CALCULATION I � � �
T 6 �,
1. 1.25% of Contract Price* or Minimum Fee ($35.00)
�� �� �v �-$ �ss�s v
(contract price)
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit. x .0005 $
(contract price)
or $.50, whichever is greater
3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � 7, p�
* 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 materia, equipment, labor,or installation are furnished by the owner,
ter�ant or a�zy ocher 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 Ci�y may request the submission of a signed copy of the actual contract.
** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
greater. For valuations over $1,000,000 call the Department of lnspectional Services for the price.
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 statem�nts made on this application are complete, true and
correct.
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Applicant's Signature: � i�`%'�� Date: �,ZS—��
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� DATE TIME
CITY OF ORONO CALLED IN 7 �/l�"
INSPECTION NOTICE scHE�u�Eo —L1�1-�'�.3 �
PERMIT NO. y J/)(o � � COMPLETED
ADDRESS f i����sL��� �-��
OWNER . CONTR. ��Cl� ��z�-/✓`�
TELEPHONE N0. ��� �� � � �����
� DESCRIPTION v�"-<- �-�- � ���� ���
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 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 O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 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:�YES_NO _ j
� COMMENTS: ` �YYI�t_ f`�ll.,` �1.�1 (_.�( Q.�, y1 �F�'Z �t �( ,
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W� WORKSATISFACTORY:PROCEED PROJECTCOMPLEfE
W ❑CORRECT WORK 8�PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
� 0 CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
� BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL AETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CAII INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952� 249-46QQ
OwnerlContractor n ite:
Inspector.
White Copyllnspector's ile Canary Copy/Site Notice