HomeMy WebLinkAbout2016-01539 - water softener CITY OF ORONO * 2 0 1 6 - 0 1 5 3 9 *
�. 2750 KELLEY PARKWAY DATE ISSUED: 12/14/2016
- "r ORONO,MN 55356-
\ (952)249-4600 FAX: (952)249-4616
ADDRE�S : 2695 KELLY AVE
PIN : 20-117-23-14-0008
LEGAL DESC : CARMAN COVE
: LOT 002 BLOCK 001
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER SOFTENER
NOTE: NEW:WATER SOFTNER
VALUATION OF PLUMBING 500
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.25
CULLIGAN SOFT WATER SERVICE CO. MAIL-IN FEE 2.00
6030 CULLIGAN WAY
MINNETONKA,MN 55345- TOTAL 52.25
(952)912-7379 Payment(s)
CREDIT CARD 5107 52.25
OWNER
KIEPER,MARK&POLLY
2695 KELLY AVE
EXCELSIOR,MN 55331-
AGREEMEIVT 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 dces
not grant permission for additional or related work which requires separate
permiu. 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 conshvction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause. Q�
(�►'/
. c�c�..�-� I��:�u l'� �y,l c�
Applicant Permitee Signature Date Issued By Signature Date
, .12/14/2016 09:04 FAX 9529395049 CULLIGAN MNTKA f�004
CI�]/ Of OI'O[lb ;,i;!;`�;�°i'��i,r;�i;;;�;'F.OR�CI�!,US���Q�V.1.Y;"'';�"
� ��O P.o. Box 66 ;Date��ReceiVetl:;��.�'''� ,�`I ,u�.��.�M,t;1
, -,_.i:;�:.�'^;;r;Ax'�;;°;�„����,;�di����',:�
2750 Kellay Parkway ,.,.,,,;,,,.,,��;�,�.�;�i^;����,,,;w;,��--,�, �;��� �.,, ;,,,
a Crystal 8ay,MN 55323 �.piy�',1 ����""'"�";"� :u�i�: �, .�
er 'it,#,s� . ��::�. "'����„!�y�� „�
'� ,. '' .,,. .���;�...,,.�;�;� :,�;; , ,�4L, i,. uI:�G�Id�;^�,,.�
�` (952)249-�600-Main � i�" ��r����NI� ���^ '1:17::.'
`'`x sxo4 (852)249-4816-Fax ��A pr;°vedw�B�iw ���� ;;�.,r,� �';��; W;i,;; .,;��;�,,,�
�H�i.i r�nMi�n�I�4��.1�n��.�.'�;�f�+�iiiG��'i.�� ����IM';1�i••��.�u�l+' r,M iiwi I�i ey��1
�Amount�:'�'�9"i�'.I`,�' w�:i.'1Gi��i�:��l'� �WPIr4�n m ri.nq'�7.�'HI�'���H'�'
CITY OF ORONO—PLUNlBlNG PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
htt :l/www,dli.mn. ovlCCLD/PDF! e lumb lanreva . df .
F,��y � itl� �F, � ;iiI�M�Vui�i�wnlw�i�NM��lll�����"u�In��y1�IL�bM1W�Y.Iw�Wlr��m���?�iIJ���u�ii'ii�lii�'W4��„�i111w�y.I�i �YIwiI�,WrtIMY!^�IM�Ir��l w�'n�I.�nwi�IIFMN�IMi��:l:��n7i
�.Y� �ii�� InI�ORMATION'Iiy,�7JiiMi11u1����µwwNii�PI�I��MNiVi1�IIni01'�+wi�iJli.Ilil Y u ��A����• � �rI'A^ � ' nM�
,�!1�M" �.�4�n7i���i��.��;a":"��.W���I�Iw.^Iw��iuiW���r�,�1.w�'P��'��.w�in�n.;11�n'L'�'MIII`nW.w1�W�I
� , ,.,,,,,, �.���.,� , ,,,,.,�,�...,., .��� H����� .
1. You may apply for plumbing permits by mail or in person at the City offices_ Applications wil!be
reviewed and a permit will b�issued within iwo working days.
2. Permit cards will be sent by retum mai!after a review is complet�d. PERMITS ARE NOT VALID
UNTIL YOU R�C�iVE A PERMIT. WORK MUST NOT B�G1N UNTIL THE pERMIT GARD IS
POSTED pN THE JaB SITE.
3. Plumbing permits may be issued ONLY to licensec!plumbing contractors and to property owners
residing in the dweUing.
4_ When any new construction or remodeling is involved, a separate building permit must be obtained_
5. All work must be done in accor�dance with State Code requirements.
6. y411 work must be inspected and air tested before it is covered. Call(952)249-4600.
(24-48 hour notice required)
"��1"��:���:�ia�����c��r..i„, .�a. ��,ia .���. �r ;i�� .��w.�,���;w,�,.��,._,.� � �^.;�:e�:�;�.�M�
4, •Ly i� ' �wti;i���".�ila,�.r���1��T'�I���;�w�'�• C + I� i T�I{�1G�,.,��ai;",;.i w��H�.�:�.� I I,LlsnwGla�i.:i���6�i:"ii..
��r4�h� au�,�„i.,�:�w��,.,I..y;;; ��;���x,,,,k,: ��,��,•",yl:l(PE:,O�i;P,E,R,M���ec �,AIf,Thaf.�A� t „a�i�� :��,ii'I�rn:.,,�, t7 �,n �M�;���i��.
�� j
�IaW,,,«��.�.,,��,��.,� ,��„� 7 � <, :iW,,rr u,,,..,.�,.�„ a � . C � �n�,.�„���w,.,.ppy � , � �Iy'1��.��;.�.,,,;�
�,nrtM��'�'�r,:,�:"..�I.�.rl.�.���,1;'��'��'II�F�G�7 �ndi�o-w�d��ii
�Residential ❑ Commeraal(Approval Required) [Bacl�low Device:❑A'V� ❑�vB�
�] New ❑Additionaf ❑ Repairs ❑ Replace
/ �
❑ ln Accessory 5tructure?
'You will need orior aooroval and may need CUP. (Per Orono City Cod�, Chapter 78,Article 11�
n � u N� ��i�hW..iF,�i,�w h 9 �trv,'nl M�s'IS:�'��"���m,I�Q.a�G'�„G�41'"C�:I'
���Jo'�::5[�e,J;�'wn�r��rifoimation;i�:���;�:��,iWiw:�".„;,����.���
Site Address: 6
Owner: �`�10�� �e�-✓" Mailing Address:
City: Zip:
Home Phone: ___ bl a- �`�a' MSd1 Alternate Phone:
�,'L'�,o11�f3C�o,C';�17�o�C11'2tionr.�i;ii"��ry°'Mi I"`I'.�„�;��''7G"z�''�i'"��;;.5:
Contractor._�,������ warER C�DNDtTIONr�i(�ontact Person:
6030 CULLIGAN WAY �
Address: � � A MiV 55345 State Bond #�
;: ` ($52) 933-�'2b0 . .
C�y: " Zip: Expiration Date:
Phone: Afternate Phan�: - 1� e� �3 I�]
[] Insurance—Current:
PBge 1
12/14/2016 09:04 FA% 9529335049 CULLIGAN MIVTKA �005
;L�'��ra��,�:� � . :����'�����,��1�����;�'E���R��, �,�:G��T�'�;"'CE�3:;�������`�;:���-���"���,�.�„�„�;�;�,
. "� dxM�i' �7� � � ar m w�r+n.��roi
�
FUCTUR� BSMT 1�T 2ND OTHER FIX7URE BSMT 1ST 2"D OTHER
IYP� Floor �loor 7YP� Floor �loor
Water Closet Floor Drains
l.avatary Sewer�jector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Neater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous
` �r' IA I!A ul 1� JV r� tiY�!•7i1MN����� i �f�/�•iMlili.M. I W'�`, � n. �
1. CONTRACT PRICE *is 1.25% of contract price with a (AAinimum Fee of$50.00)
�O4 � x _0125 $
(contract price) (minimum$5Q.00)
, 2_ STATE SURCHARGE
x .0005 $
(contract price)
3_ POSTAGE�HANDLING (Onty on Mail-In Applications) $ 2.00
a. TOTAL PERMIT FEE (Add �.ines 1-3 Above) $ .��, �
"' CONTRACT PRICE or JOB COST means the actual or estimated dollar amourrt charged for the
permitted work including materials, labor, profit, and other fixed costs. It is the amount fio be charged to
the custom�r for the work done. If any mat�rial, equipmerrt, labor or installations are fumished by the
owner, tenant or arry other party, the reasanable market value of such iterns must be added ta tha
estim�ted cost or contract price for permit fee purposes. ln.the event that there is a dispute on the
amount of the job cost, the City m�y request the submission of a signed copy of the actual corrtract.
Rrp!!� r 1 ��`y/y,�,N I��/���y� �IN y !� II
IA PQ � 1 I . '+'N-`.0 �M M� i.i�7r tl � Y1r iY� � i ,NN
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 sfatements made on this application are complete, true and correct.
Appficant's Signature: Date: ��'�- �b
Building O�icial/Inspector: pate:
Page 2