HomeMy WebLinkAbout1997-008947 - vacuum breaker - spkle �. PERMIT
GTY OF ORONO PERMIT TYPE: : ::-;W. ;
� 2750 Kelley Parkway- P.O. Box 66 �='" " ` ���
Permit Number: '::�::s=�;'`-��.�:����
Crystal Bay, Minnesota 55323 -
(612) 473-7357 Date Issued: _ ...,'==f;�
SITE ADDRESS:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: � ��'='_'� '-=�'�'� �" OWNER:
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APPLICANT-PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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�ox 6� (2750 Kelley Parkway)
�ry�ta� �ay, I�IIET 55323
GENEF�4,L IlVFO1�1VfAT'IQN
1. You may apply for plumbing permits by mail or in person at the City offices.
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 CARB 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 sepazate building permit must be obtained.
5. All work must be done in accordance with the State Code requirements.
6. All work must be inspected and air tested before it is covered. Ca11473-7357. 24-hour notice required.
�nstructio��,� Co:nplete aIl items on this application. Coinpute the permit fee. Sign and date
the certification. II�COIl9PLETE APPLICATIONS WILL NQ�BE PI�OCESSEB. If you have
questions, call 473-7357.
Please check one: New Addition Repair �✓Replace
Residential Commercial
.�E�� S�'!i'E: ;2-S 1 � � u-C- zip:
Owner's Na�e: �elegP�one 1�lumber:
1VV��ilingAc�c�ress: �S /� �ti-t City: Zig:
�ontractor'sl�am� � Ga� eiephaneN ber: ,�— ZZ-/
1VV��iling�i.dc�ress: City: Zip: S 5 3� )
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I�LUIvfI�ING� FII�TURE SC�EDUI.E
FIXTUR.E BSMT 1ST 21�►D OTHER FIXTURE BSMT 1ST 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishw.�sher Wet Baz
Sillcocks Misc (list) � Gz���?�
-- S �3GI � � (
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1. 1.25% of �Contract Price* ar l��li,nimum F�e (535.l�)
x .0125 $
(contract price)
2. State Surcharge. ** Add the State Building �ode Division
Surcharge to each permit. x .0005 $
(contract price)
or $.50, whichever is greater
3. Postage and Handlin�; (Only mail-in appiications) $ 1.50
4. TOTAL PE�tMIT FEE (Add lines 1-3 above) $
* CONTRACT PRICE or JOB COST means the actual orestimated dollaz amount chazged for the permitted
work including materials, labor, profit, and other fued costs. It is the amount to be chazged to the
customer for the work done. If any material, equipment, labor,or installation are fumished by the owner,
tenant or any other parry the reasonable market value of such items must be added to the estimated cost
or contract 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 contract.
** The STATE SURCHARGE is .0005 of che �ontract price under $1,000,000 or $.50 - whichever is
greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
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 statements made on this application aze complete, true and
correct.
Applicant's Signature: Date: