HomeMy WebLinkAbout2005-P08852 - shower � PERMIT
CITY �F ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 Pos852
Crystal Bay, Minnesota 55323 Permit Type: Fixtures
(952)249-4600 Date Issued: 6/16/2005
SITE ADDRESS: 565 Leaf Street Unit#
Long Lake,MN 55356
P��� OS-117-23-41-0028
DESCRIPTION:
Proposed Use: Residential
Permit Class: Plumbing
Pernut Type: Fixtures Pernvt Sub-type(s): Shower
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernrit Fee: $ 15.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 15.50
APPLICANT: Steve Santema Plumbing OWNER: Kosierazki&Fox
4407 Locke Ave SW 565 Leaf Street
Cokato,MN 55321 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 STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
�'l'""`�fQ/ � �`� ' �
APPLICANT PERMITEE SI NATURE - ISSUED BY SIGNATURE
Copies: 1-File(SignaturesRequired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
FOR CITY.USE ONLY
�,�a�� City of Orono _
P.O.Box 66 Date Reeeived: Pe�mit#
2750 Kelley Parkway
a�, ��� Crystal Bay,MN 55323 Approved By: Amount$:
����, (952)249-4600
�LTY C�F OItO�l�T�—PLUMBING PERMIT
(All Commercial permits must be approved by the Building O�cial or Inspector)
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City offices. Applications will be
reviewed and a permit will be issued within two working days.
2. Pernut cards will be sent by retum mail after a review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE
PERMIT CARB tS PQSTED ON THE 30B SITE.
3. Plumbing perinits 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 pernrit 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
�`Residential ❑Commercial(Approval Required)
❑ New ❑Additional ❑Repairs ❑Replace
❑ In Accessory Structure?
*You will need urior anqroval and may need CITP.(Per Orono City Code,Chapter 78,Article I�
7ob Site/Owner Information:
Site Address: .��� ��.�� s�
Owner: Mailing Address:
� Cl�. Zlp.
Home Phone: Alternate Phone:
Contractor Information:
Contractar: S7`cdP s•,�,�`�,L,� I`/,b�, Contact Person: ,�
Address: S/'Yo 7 �mC��. �✓,e 54� State Bond#:
City: tc� _ Zip;�� Expiration Date:
Phone: �,�-�f�--/�/�' Altemate Phone:
❑ Insurance—Current:
1
' ` ` PLTJIVIBII�'G.F.TXTLTRES BEThTG iNSTALLED , , .'
FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 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 Sof�ener
Dishwasher Wet Bar �
Sillcocks Miscellaneous
. PERMTT�'EE C�I.CULAT��1�(�).� . , . �
:BASED O�'F - �002 STATE`���TUE.
� Yes,this section applies
The replacement of a Residential fixture or appliance that meets all three of the following requirements:
1. Does not require modification to electrical or gas service.
2. Has a total cost of$500.00 or less; excludinQ the cost of the fixture or appliance: and
3.— Is improved,installed or replaced by the homeowner or licensed contractor.
Skip next secrion,if this applies; Cost of Pernut $ 15.00
State Surcharge $ .50
Mail-In Fee(If Applicable) $ 1.50
Total Permit Fee $
(Permit Fees Continued On Next Page)
2
- PERNI.IT FEE,CALCULATION.S -JOBS OVER$Sa0.00 , `
If above does not apply;follow guidelines below:
1. CQNTRACT PRTCE *is 1.25%of contract price with a(Minimum Fee of 535.00)
x.0125$
(contract price) (minimum$35.00)
2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50)
x.0005 $
(contract price) (minimum$ .50)
3. POSTAGE&HANDLING{Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
■ * CONTRACT' PRICE or JOB COST means the actual or esrimated dollar amount charged for the
permitted 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 installarions are furnished by
the owner, tenant or any other party, the reasonable market value of such items must be added to the
estimated cost or contract price for pemut 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 the contract price under$1,000,000 or$.50—whichever is
greater. For valuarions over$1,000,000 call the Building Deparhnent at(952) 249-4600 for the price.
` PLUII�IBING PERMIT APPL:ICA'T�OAT.AGGREEME�'I'' "
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 are complete, true and
correct.
Applicant's Signature: ��_ e�`— Date: _ --p
�
3
�" \ � ATE TIME v
TY OF ORONO CALLED� 1����
INSPECTION NOTJ�EG SCHEDULED _1��—L� 3 �L2?
PERMIT NO. t��vO � COMPLETED
ADDRESS �'f
OWNER CONTR. —
p ,
TELEPHONE NO. I� �cs I(D � (p( `'��
� DESCRIPTION �
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL �/ 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:i,�.YES_NO
� COMMENTS: r�
�
W
a
J �/(/�
O
�
�
O
�
W
�
Q
�
Z
W
�
W
�
j
O
W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE
W ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑ CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
C INSPECTION REQUiRED.CALL TO ARRANGE ACCESS.
Cal1 for the n x inspection 24 hours in advance. (952� 249-4600
OwnerlContra n it :
Inspector.
White Copyllnspector's File Canary Copy/Site Notice