HomeMy WebLinkAbout2011-01311 - plumbing�
•�"' CITY OF ORONO PERMIT NO.: 2011-01311
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 10/24/2011
(952)249-4600 FAX: (952)249-4616
ADDRE$S : 205 HOLLANDER RD
PIN : 25-118-23-44-0011
LEGAL DESC : HOLLY ACRES 2ND ADDN
: LOT 000 BLOCK 001
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURE
NOTE: WATER SOFTENER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
CULLIGAN SOFT WATER SERVICE CO. STATE SURCHARGE PLBG(<$500) 5.00
6030 CULLIGAN WAY
MINNETONKA,MN 55345 MAIL-IN FEE 2.00
(952)912-7379 TOTAL 22.00
PAID WITH CC# 0597
OWNER
BURNS,DAVID&CASSIDY
205 HOLLANDER RD
WAYZATA,MN 55391
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due use.
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Applicant Permitee Si nature Date Issue y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
10/24/2011 13:28 FAg 9529335049 CULLIGAN MIVTRA C�002
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FOR CITY USE ONLY
City of Orono �.,h t�/
�'�'� P.O.Box 66 Dato Reoeived!v h Permit�I�l� /�
2750 Kclley Perkway
O�i�'? t Crystal Bay,MN 55323 APproved By: Amoun�$: �
���.6� (952)2A9-4600
CITY OF ORONO—PLUMBING PERMTT
(All Commercial pertnits must be approved by the Huilding OfFcisl or lnspector)
GENERAL INFORMATION
l. You may apply for plumbing permits by mail or in petson at the City offices. Applications will be
reviewed and a permit will be issued within two working days.
2. Perrnit cards will be sent by return mail after a roview is completed. PERMITS ARE NOT
VAL1D UNTIL YOU RECETVE A PERMIT. WORK MUST NOT BEGIN UNTYI.THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Plumbing permits 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 permit must be
obtained.
5. All work must be done in accordance with State Code requirements. .
6. All work must be inspected and air tested before it is covcred. Call(952)249-4600.
(24-48 hour notice reqaired)
TYPE OF PERMT'1'
Check All That A 1
�Residential ❑Commercial(Approval Required)
�New ❑Additional ❑Repairs ❑Replace
❑ In Accessory Structure?
*You will need arior anaroval and may need�1P.(Per Orono City Code,Chapter 78,Article f V)
� Job Site/Owner Information:
Site Address: �QS �l 0��C►n KO c��
Owner: �Gv�c� ��,.�c n S Mailing Address:
city: zip: S53Z I
Home Phone: 9'Sa- �C13 � �y94 Alternate Phone:
Contractor Information:
Contractor: Contact Person: IJ�► �
GULLIGAN WATER CONDITIONING State Bond#:
Addr�g0 C
MINNETONKA, MN 553�r
� City_ �g52� a��_�on� Gip: Expiration Date:
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, Phone: Altemate Phone: 9sa• 91�_ �31�
❑ Insurance—Current: �
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10/24/2011 13:28 FAX 9529335049 CULLIGAN MNTRA f�003
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FIXTURE BSMT ] 2 OTHER FIXTURE SSMT 1 2 OTHER
7'YPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower W asher
Kitchen Sink Water Heater
. _. .
Disposal Water Softener �
Dishwasher Wet Bar
Silicocks Miscellaneous
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� Yes,this section applies
The replacement of a Residential fixture or appliance that meets all three of the following requirements:
1. Does not require modification to elecdrical or gas service.
2. Has a total cost of$500.00 or less; c in tha cost of the fixture or appliance:and
3. Is improved,installed or replaced by the homeowner or licensed wntractor.
Skip ncxt section,if this applics; Cost of Permit S 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) S 2.00
Total Permit Fee S
(Permit Fees Continned On Next Page)
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10/24/2011 13:28 FAX 9529335049 CULLIGAN MNTRA f�004
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If above does not apply;follow guidelines below;
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of 550.00)
x.0125$
(contract price) (minimum$50,00)
2. STATE SURC�A_RGE *'`Add the State Bldg Code Div. Succhsrge(Minimom Fee of S5.00)
x.0005 $
(wntrnct price) (minimum S 5,00)
3. POSTAGE&HANDGING(Only on Mail-In Applications) $ Z•00
, . _ _ A. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ aa .��
■ "` GONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
pem�itted work including materials, labor,profit,and other fixed costs. lt is the amount to be charged
to the customer for the work done. If any matcrial,equipmcnt, Isbor or installations are fumished by
the owner,tenant or arry other party,the reasonable market value of suc6 items must be added to the
ostimated cost or comract 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 cont�act,
• *'�The STATE SURCHARGE is.0005 of the contract price under 51,000,000 or$5.00—whichever is
greater. For valuations ovar$1,000,000 call the Building Depariment at(95Z)249-4600 for the price.
The undersignad hereby applies to the City for issuance of a Plumbing Permit, agrees to do a!1
work in strict accordanca 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: D Date: �� - ay - ��
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