HomeMy WebLinkAbout2005-P09268 - vacuum breaker � PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: po9268
Crystal Bay, Minnesota 55323 Permit Type: Vacuum Breaken
(952) 249-4600 � Date Issued:
I 10/6/2005
SITE ADDRESS: i 3085 Jamestown Rd Unit#
' Long Lake,MN 55356 ,
P��� 28-118-23-33-0010 �
DESCRIPTION:
Proposed Use: Residenrial
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Permit Class: P!lumbing
Permit Type:
Vacuum Breaker Pernut Sub-type(s): Vacuum Breaker
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DETAI LS: ,
Approved per resolution#:
Separate pemuts required:
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NOTICES/REMARKS:
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FEE SUMMARY: Permit Fee: $ 35.00 valuation: $ 400:00
State Surcharge Fee: $ 0.50
Misc.Fee: $ 1.50 I
TOTAL FEE: $ 37.00
APPLICANT: Weld&Sons Plumbing Company,Inc. OWNER: Mr.&Mrs. Gary Larson '
315 Juneau La 3085 Jamestown Rd
Plymouth,MN 55447 Long Lake MN 55356
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 S'�ATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) I Page 1
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CITY OF ORONO APPLICATION FOR PLIJI�iBING PERMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, l�IN 55323
GENERAL LYFOR�IATION
1. You may apply for plumbing permits by mail or in person at the City offices.
2. Permit cards will be sent by retum mail after a review is completed. PERMITS ARE NOT VALID
UNTIL YOU RECENE A PERMIT. WORK MUST NOT BEGIN UNTII.. THE PERMIT CA.RD IS
POSTED ON THE JOB SITE.
3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to properry owners residing
in the dwelling.
4. When any new construction or remodeling is involved, a separate building permi[ must be obtai.ned.
5. All work must be done in accordance wich the S[ate Code requirements.
6. Aii work mus� oe inspeaed and air tested'oefore it is covered. C�I 24y-�+o00. 24-hour notice required.
Instructions Complete all items on this application. Compute the permit 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
�_ Residentia Commercial
JOB STTE: �G�� Tt7�v''��5-�-�,•.�1� -��,���� (��J.�v �'U1tii Zi ;i S�5�
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Owner's Name: ' ��,n Telephone Number:
I�iailing Address: r�� ' e.. City: Zip:
Contractor's Name: Telephone number:
Mailing Address• �$K�Itti'10 ��,: Zip:
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PLUMB� SCHEDULE L�L��4�:� `1 W����
FIXTURE BS�1T IST 2ND OTHER FIXTURE BS�iT 1ST 2ND OTHER
TYPE FL FL TYPE FL FL
— _ _. _. �---
Wacer Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
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Sillcocks Misc (list) , -p�. ��—
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PERMIT FEE CALCULATION
1. 1.25% of Contract Price* or Minimum Fee ($3�.00)
W ��.'r .�;!rv x .0125 $ °.7 . (i
(contrac[ pr.c�)
2. State Surcharge. ** Add the State Buildin� Code Division
Surcharge to each permit. x .0005 $ i �
(contract pr.x)
or $.50, whichever is greater
3. PostaQe and HandlinQ (Only mail-in appli:.ations) $ 1.50
4. TOTAL PERNIIT FEE (Add lines 1-3 above) $ � .(g�
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* CONTRACT PRICE or JOB COST means the actuzl or estimated dollar amount charged for the permitted
work including materials, labor, profit, and other h�ed cosu. It is the amount to be charged to the
cuscou�er for the work done. If any macerial, equip��n[, labor, or installation are furnished by the owner,
tenant or any ocher party the reasonable market v�:•_e of such items must be added to the estimated cost
or contract price for permit fee purposes. In the eve�_ �at[here is a dispute on the amount of the job cost,
the Ci�y may request the submission of a signed co�;: of che actual contract.
** The STATE SURCHARGE is .0005 of the contr��: price uader $1,000,000 or $.50 - whichever is
greater. For valuations over 51,000,000 call the D:�zrtment of Inspectional Services for the price.
The undersigned hereby applies to the City for iss��r_ce of a Plumbing Permit, agrees to do all
work in strict accordance with the ordinances of t�e City and the regulations of the State of
Minnesota, and certifies that all statements made en this application are complete, true and
correct.
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Applicant's Signature: /�� Date:
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