HomeMy WebLinkAbout2012-00739 - plumbing v - CITY OF ORONO * Z 0 1 2 - 0 0 7 3 9 *
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! 2750 KELLEY PARKWAY DATE I SUED: 08JOU2012
ORONO,MN 55356-
' (952)249-4600 FAX: (952) 249-4616
ADDRESS : 2670 KELLEY PKWY �Zl�j
PIN : 33-118-23-12-0067
LEGAL DESC : STONEBAY OF ORONO CONDOMINIUM
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION'�'YPE : FIXTURES-MULTIPLE
NOTE: 2 WC,3 LAV,,1 TUB, 1 SHOWER, 1 KITCHEN SINK, 1 DISPOSAL, 1 DISHWASHER, 1 WAHER
VALUATION OF PLUMBING 4000
APPLICANT pLLTMBING FIXTURE FEE 50.00
AMERICAN MECI�ANICAL CO,INC. STATE SURCHARGE PLBG(VALUATI N) 2.00
7120 71ST AVE.N.
PO BOX 205 ' MAIL-IN FEE 2.00
LORETTO,MN 55�57- MISC FEE 0.00
(612)750-0278 TOTAL 54.00
OWNER
Citizens Independent Bank
5000 36TH ST W
ST LOUIS PARK,MN 55416-
AGREEME T AND SWORN STATEMENT
The work for which this jpermit is issued shall be performed acwrding to
the approved plans and specifications,applicable City approvals,and the
State Building Code. Tt�is permit is for only the work described and does
not grant permission for�additional or related work which requires separate
permits. All provisions pf laws and ordinances goveming this type of work
shall be compied with w{hether or not specified herein.This permit will
expire and become null$nd void if construction authorized is not
commenced within 180 klays of the date of issuance,or if construction is
suspended for a period qf 180 days at any time after work has commenced.
The applicant is respon�ible 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'
i��� �- / / ��'�- / /
Applicant Permitee S'gnature Date Issued By Si ature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB VE.
�
FOR CITY USE ONLI'
,¢�� City of Orono
,� �, P.O. Bo�66 Date Received: Permit#
- �. 2750 Kelley Parkwa�
.+ *- �' Crystal Bay,MN 55323 Approved By: Amount$
�'�� ' ; o`,' (952)249-4600—Main
� �saxo�'``�� (953)249-4616—Pa�
CITY OF ORONO — PLUMBING PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
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GENERAL INFORMATION
I. You may apply for plumbing permits by mail or in person at the City offices. Applications wi(I be
reviewed and a permit will be issued within two working days.
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 S[TE.
3. Plumbin�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 covered. Call (952)249-4600.
(24-48 hour notice required)
TYPE OF PERMIT
(Check All That A 1
�Residentiai ❑ Commercial (Approval Required)
❑ New �Additional ❑ Repairs ❑ Replace
❑ In Accessory Structure?
*You will need prior approval and may need C'UI_'.(Per Orono City Code,Chapter 78,Article IV)
Job Site/ Owner Information:
Site Address: �J'� ��' ��t"����� �'�'` ��°.+c-��
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Inforination:
Contractor: � ' � ���P ,dnr Contact Person: � ( ��''�t - ?" �'i
r
r� /
Address: � `��x" �>\ State Bond #: ��- �����/ �' ��
City: CU�i�t; Zip���� Expiration Date: �� �� ;
Phone: ��" /�Z�� ��,�7 J Alternate Phone: �(l',�-� ��7� '����_
� Insurance—Current: ��'�
1 �
.
PLUMBING FIXTURES BEING INSTALLED
FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 L' OTHER
TYPE FL FL TYPE FL FL
Water Closet � Floor Drains
Lavatory � Sewer Ejector
Bathtub � Laundry Tray
Shower � Washer I
Kitchen Sink ( Water Heater
Disposal � � Water Sofier.Pr
Dishwasher ( Wet Bar
Sillcocks Miscellaneous
i
i
� � ��PERMIT FEE���CALCULATION(S)� � � + �
�3ASED OFF - 2002 STATE S'TATUE
❑ Yes,this section applies
The re lacement of only one Residential fixture or appliance that meets all three of the following
P
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
�. Is improved, installed or replaceci by the homeowner or licensed plumbing car.tractor.
Skip next section, if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(lf Applicab(e) $ 2.00
Total Permit Fee $
(Permit Fees Continued On Next Page)
2
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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$5 00�
'��/ � x.0125$
(contract price) (mmimum 50 00)
I�� 2. STATE SURCHARGE '
�(�d x.0005 $
(contract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2A
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
■ * CONTRACT PRICE or JCB COST means the actual or estimated �ollar amount char ed fc,r ?he
permitted work including materials, labor,profit,and other fixed costs. It is the amour.t to �charged
to the customer for the work done. If any material, equipment, labor or installations are f r�ished by
the owner, tenant or any other party, the reasonable market value of such items must be a c�ed to the
estimated cost or contract price for permit fee purposes. In the event that there is a dis ujte on the
� amount of the job cost, the City may request the submission of a signed copy of the actu l��contract.
FLUl�BTN'G�� .... T�il'T?�I�AT���'��'���1��'T
The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees o do all
work in strict accordance with the ordinances of the City and the regulations of the State of
Mirinesota, and certifies that all statements made on this application are complete, 'rue and
cornect.
� Date: ��✓�'��
Ap�,licant s Signature:
: ' 1��58# FOI"�'ti=i
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