HomeMy WebLinkAbout2015-01460 - water heater CITY OF ORONO * Z 0 1 5 — 0 1 4 6 0 *
� 2750 KELLEY PARKWAY DATE [SSUED: 1U12/2015
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2545 KELLY AVE
PIN : 20-117-23-11-0023
LEGAL DESC : TOWNSITE OF LANGDON PARK
: LOT 002 BLOCK 005
PERM[T TYPE : PLUMBING(<$500)
PROPERTY TYPE : RES[DENTIAL
CONSTRUCT[ON TYPE : WATER HEATER
NOTE: REPLACE WATER I-iEATER
APPLICANT PLUMB[NG FIXTURE FEE(<$500) 15.00
STATE SURCHARGE PLBG(<$500) 1.00
APPLIANCE CONNECTIONS, INC. MAIL-IN FEE 2.00
12850 CHESTNUT BLVD
SHAKOPEE,MN 55379- TOTAL 18.00
(952)445-4803 Payment(s)
Minnesota State License#:mech-MB004165 CHECK 7822 18.00
OWNER
PONZETTI, ROBERT& BARBARA
2545 KELLY AVE
EXCELSIOR, MN 55331
AGREEMENT AND SWORIv STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of Iaws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature � Date Issued By Signature Date
� FOR CITY USE O LY
�,�(y�� City of Orono ,,, �t�
P.O.Bos 66 Datc Received: ��'� �C L �Permi # /��� �j� ��L���
2750 Kelley Parkway 1
� '"� +� Gystal Bay,MTQ 55323 �,,,�,' �(J �
�' . � o� (952)24J-4600—Main APproved BY Atnou t$: �T
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��° (952)249-4616-Fax
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CITY OF ORONO — PLUMBING PERMI�
(All Commercial Permits Must be Approved by the State Prior to City App �oval)
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GENERAL INFORMATION
1. You may apply far plumbing permits by mail or in person at the City oftices. Applic tions will 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. PERMTTS ARE NOT
VALID UNTIL YOU RECEiVE A PERMiT. WORK MUST NOT BEGIN UNTI THE
PERMiT CARD IS POSTED ON THE JOB SiTE.
3. Plumbing pern�its may be issued ONLY to licensed plumbing contractors and to pro ' rty owners
residing in the dwelling.
4. When any new construction or remodeling is involved,a separate building permit mu t be
obtained.
5. All work must be done in accordancc with State Code requirCments.
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
�esidential ❑ Commercial (Approval Required)
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❑ New ❑Additional I
❑ Repairs r Replac�
Tn Accessory Structure?
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*You will need nrior apnroval and may need{ �!i'. (Per Orono City Code,Chapter 78,,Q�rticle N)
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Job Site/Owner Information:
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Site Address: �,.
Owner:�(� ���j�l']�P'��J Mailing Address: ��� '��'�� �(��
Ciry: _ :�i�'G-�l7 % � < " �
— Zip: ��J�
-�Fem�-Phone: (G'��' �j 7- � / � Alternate Phone:
Contractor Information:
Contractor: ContactPerson: ���Z` � �� ��: �
Appliance Connections tnc.
Address: 12$,5n e:►,A tn 1 Blyd. State Bond#: � � �
Shakopee, MN 55379
City: q��_d45,�_ Expiration Date:
Phone: Alternate Phone:
❑ Insurance–Current:
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PLUMBING FIXTURES BEING INSTALLED,
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FIXTURE BSMT 1 2 OTHER FIXTURE BSMT ls OTHER
T�'E FL FL TYPE FL L
Water Closet Floor Drains I
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower w Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks , Miscellaneous
PERMIT FEE CALCULATiON(S)
BASED OFF -2002 STATE STATiJE
❑ Yes,this section applies
The replacement of onty one Residential fixture or appliance that meets all three of the followu g
requirements: ,
1. Does not require modification to electrical or gas service.
2. Has a total cost of$500.00 or less;cxcludine the cost of the fixture or appliance: nd
3. Is improved,installed or replaced by the homeowner or licensed plumbing contra tor.
Skip next section,if this applies; Cost of Pernut' $ 15.�0
State Surcharge $ �-- 1, U��
1VIai1-In Fee(If Applicable) $ 2.G0� � l
Total Permit Fee $ i�
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(Permit Fees Continued On Next Page) I
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If above does not apply;fo(low guidelines below:
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1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$l50.00)
• x.0125$ I�'
(conUact price) . (m�nunu 550.00)
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2. STATE SURCHARGE #*Add the State Bldg Code Div.Surcharge(Minimn�n Fa of S5.00)
x.0005 $ , ,
� (contract price) ' (m tmm�' � ytn S 5.00)
3. POSTAGE&HANDLING(Only on Mail-Tn Applications) $ �.00
4 PERNIIT�EE Add Lines 1-3 Above � $ � ���
. T�TAL ( )
� ' CONTR.AC'T PRICE or JOB COST means the actual or estimated dollar amount dharg,ed for the
permitted zvork 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 instal�ations a�!e furnished by
the owner,tenant or any other parcy,tlie reasonable market value of such items must lie added to the
estimated cost or cont�act 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 snbmissian of a signed copy of the�ctual contract.
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■ **The STATE SURCHARGE is.0005 of the conttact price under$1,000,000 or$5.00�--wh�:hever is
greater. For valuadons over S1,OQ0,000 call the Building Departrnent at(952)249-4b00jfor tl, price.
The undersigned hereby applies to the City for i'ssuance of a Plumbing Permit, agjrees to do all
work in strict accordance with the ordinances of the City and the regulations o�'the State of
Minnesota, and certifies that all statements raade on this application aze complete, true and
correct. '
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Applicant s Signature: 'Vv� ti Date: ` - �