HomeMy WebLinkAbout2005-P09085 - vacuum breaker . �
PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P09085
Crystal Bay, Minnesota 55323 Permit Type:
Vacuum Breaker
(952) 249-4600 Date Issued: 8/19/2005
SITE ADDRESS: 568 Keene Ave Unit#
Wayzata,MN 55391
P��� 02-117-23-31-0042
DESCRIPTION:
Proposed Use: Residential
Permit Class: Plumbing
Permit Type:
Vacuum Breaker Permit Sub-type(s): Vacuum Breaker
DETAILS:
Approved perresolution#:
Separate permits required:
NOTICES/REMARKS:
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FEE SUMMARY: Permit Fee: $ 15.00 Valuation: $ 200.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 15.50
APPLICANT: Larson Plumbing Inc. OWNER: Donald&Joanne Davidson
3095 162nd Ln NW 568 Keene Ave.
Andover,MN 55304 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
Copies: l-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septiq 1-Septic) Page 1
� * �
FOR CITY USE ONLY
�,�` City of Orono
O� `YO P•O.Box 66 Date Received: Permit#
;,�;.r� 2750 Kelley Parkway
a '�j��l�,�� �. Crystal Bay,MN 5�323 Approved By: Amount$:
� �������.�u` (952)249-4600
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CITY OF ORONO —PLUIVIBING PERMIT
(All Commercial permits must be approved by the Building Official or Inspector)
GENERAL INFORMATION
1. You may apply for plumbing peinuts by mail or in person at the City offices. Applications will be
reviewed and a pemiit will be issued within two working days.
2. Pernut cards will be sent by retuin 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 pernuts may be issued ONLY to licensed plumbing contractors and to property owners
residing in the dwelling.
4. When any new consh-uction or remodeling is involved, a separate building pernut must be
obtained.
5. Ali work must be done in accordance with State Code requiremeuts.
6. All work must be inspected and air tested before it is covered. Call(952)249-4600.
(24-48 hour notice required)
TYPE OF PERMIT
(Check All That Apply)
[t}'�sidential ❑ Commercial(Approval Required)
❑ New ❑Additional ❑ Repairs ❑ Replace
❑ In Accessory Structure?
*You will need prior anproval and may need CUP. (Per Orono City Code, Chapter 78,Article IV)
Job Site/ Owner I�iformation:
Site Address: S�v�' C\ee N P � U (�
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Infornlation:
Contractor: �v-s�o►� � �, Z.�,,` Contact Person: �ll Q.,.�,�� �i��tl 1�
Address: �0"Y5 �to���,,� �...,�vw State Bond #:
City: � �1�+�1M.►J Zip: ��'3c��( Expiration Date:
Phone: ���3 �1_'l lec�� Alternate Phone:
❑ Insurance— Current:
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PLUMBING FIXTURES BElNG INSTALLED
FI�iTURE BSMT 1 2 OTHER FIXTL'RE BSMT 1 2' OTHER
TYPE 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
Sillcocks Miscellaneous
V C�-C.c_�� `�, rQ��l�— -�'TUl� � ��Y�1 w Y��.n � l l�f �� .
PERMIT FEE CALCULATION(S)
BASED OFF - 2002 STATE STATUE
�,, Yes, this section applies
The replacemeiit of a Residential fixture or appliance that meets all tluee of the following requirements:
1. Does not require modification to electrical or gas service.
2. Has a total cost of$500.00 or less; excludin�the cost of the fixture or appliance: and
3. Is improved, installed or replaced by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surcharge $ .50
Mail-In Fee(If Applicable) $ 1.�0
Total Permit Fee $
(Pernut Fees Continued On Next Page)
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, PERMIT FEE CALCULATION(S)—JOBS OVER$500.00
If above does not apply; follow guidelines below:
1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$35.00)
r�lJ.iat� X .�12$ $
(contract price) (minimum$35.00)
2. STATE SURCHARGE **Add tl�e State Bldg Code Div. Surcharge(Minimum Fee of�.50)
x .0005 $
(contract price) (minimuni$ .50)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.�0
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) �
■ * CONTR.ACT PRICE or JOB COST ineans the actual or estimated dollar amount charged for the
pemutted 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 material, equipment, labor or installations are furnished by
the owner, tenant or any other party, the reasonable market value of such items uiust be added to the
estimated cost or contract price for pernut fee puiposes. 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 contract.
■ ** The STATE SURCHARGE is .0005 of the conh�act price under$1,000,000 or $.50 —whichever is
greater. For valuations over$1,000,000 call the Building Deparhnent at(952) 249-4600 for tbe price.
� PLUMBING PERMIT APPLICATION AGREEMENT
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
Mim�esota, and certifies that all stateinents made on this application are complete, true and
correct.
/S
Applicant's Sigr►ature: � � �lft� Date: �-�`1-U'.►
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