HomeMy WebLinkAbout2015-01459 - water heater CITY OF ORONO * Z 0 1 5 - 0 1 4 5 9 *
� 2750 KELLEY PARKWAY DATE ISSUED: 1U12/2015
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1082 LOMA LINDA AVE
P[N : 08-117-23-23-0009
LEGAL DESC : LOMA LINDA
: LOT 008 BLOCK 000
PERMIT TYPE : PLUMB[NG(<$500)
PROPERTY TYPE : RES[DENTIAL
CONSTRUCTION TYPE : WATER HEATER
NOTE: REPLACE WATER HEATER
APPL[CANT PLUMBING FIXTURE FEE(<$500) 15.00
STATE SURCHARGE PLBG(<$500) 1.00
APPLIANCE CONNECTIONS, INC. MAIL-IN FEE 2.00
12850 CHESTNUT BLVD
SHAKOPEE,MN 55379- TOTAL 18.00
(952)445-4803 Payment(s)
Minnesota State License#:mech-MB004165 CHECK 7677 18.00
OWNER
TOMAN,JULIE
1082 LOMA LINDA AVE
MOUND,MN 55364
AGREEMENT AND SWORN STATEMEI�TT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for addi[ional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within I 80 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be /) ,
revoked at any time for due cause. 1 / �,C_1
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Applicant Permitee Signature Date Issued By Signa�dre Date
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� FOR CITY USE O LY
O¢Q�O C�ty of Orono
P.O.Box 66 Datc Received: 1 iY !p�� # 2 a�� � � �� I
2750 Kelley Parkway
'''� Crystal Bay,MN 55323 A roved B P� �'
�+ ' � `G� (952)24J-4600-Main ��' Y' Amou t$:�
�ax°~ (952)249-4616-Fux
CITY OF ORONO — PLUMBING PERMI
(All Commercial Permits Must be Approved by the State Prior to City App val)
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GENERAL INFORMATION
1. You may apply for plucnbing permits by mail or in person at the City oftices. Applic tions will be
reviewed and a pennit will be issued within two working days.
2. Permit cards will be sent by return mail after a rcview is completed. PERMTTS ARE NOT
VALID UNTIL YOU RECEIVE A PERMTT. WORK MUST NOT BEGiN UNTI THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Plumbing perniits may be issued ONI_Y 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
�Residential ❑ Commercial (Approval Required)
❑ New ❑Additiona] �
❑ Repairs Replac
❑ Tn Accessory Structure?
*You will need qrior anproval and may need� i!�'. (per Orono City Code,Chapter 78,q�rticle iV)
I
Job Site/Owner Information:
Site Address: C.��o� LQYd7C�, ��rj�Q ,c��.
Owne� j�l��� ���,��1/j Mailin Address: � ���� �
g c�. yY1 C�. L�6 rlG�� ;1'�C.
City: _ ��y'� �;� �ip: �����D�
�e�ePhone: (L`�<�- ' � ��l ' ���� Alternate Phone:
Contractor Information:
Contractor: Contact Person: ; � �
Appliance onnec �ons Inc.
Address: 12850 Ch�est►1ut Bivd.
a op�, 379 State Bond#: �7 d
City: 952-�4�45�03 Expiration Date:
Phone: Alternate Phone:
❑ Insurance—Current:
1
Y.'
PLLTMBIlVG FIXTURES BEING iNSTALLED
Y ,'
FIXTURE BSMT 1 2 OTHER FIXTURE BSMT ls OTHER
T�E FL FL TYPE FL L
Water Closet Floor Drains
I
Lavatory �
Sewer Ejector i
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks , Miscellaneous
�
PERMIT FEE CALCUI,ATiON(S) �
BASED OFF -2UO2 STATE STATiIE
❑ Yes,this section applies
�
Ii
The replacement of only one Residential fixture or aopliance that meets all three of the follow�ng
requirements: ,
1, Does net require modificat:an to elect;ical or gas service. I
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 g; �.- I � (j
Mail-In Fee(If Applicable) $ .UO
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$$0.00)
• x.0125$ �
(contract price) . (miIIvnutn S50.00)
2. STATE SURCHARGE **Add the State Bldg Code Div.Surcharge(Minimnm Fec of S5.00)
�
� • � x.0005 $ ' � �
(conuact price) ' (minimum S 5.00)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ '�.p0
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $_ � y
i
• * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount qharg,ed for the
pernutted:work including matcriais,labor,profit,and ot�er fixed costs. It is the amount tobe charged
to the customer for the wark done. If any material,equipment,labor or instaliations atc furnished by
the owner,tenam or any oth�party,ttie reasonable market value of such items must t�e added to the
estimated cost or contract price for�permit fee purposes. In the event that there i,, a;dispute on the
amount of the job cost, the City may request the submission of a signed copy of the�ctual contract.
■ *•The STATE SURCHARGE is.0045 of the contract price under$1,000,000 or$5.00�wh��hever is
greater. For valuations over$1,OOO,Q00 call the Building Depariment at(952)249-4600�for tl, price.
The undersigned hereby applies to the City for i"ssuance of a Plumbing Permit, ag�ireees 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 made on this application are complete, true and
correct. �
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Applicant's Signature: ��� Date: G G � �(���
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DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED ��I �`� � � c=-'�'�`J
PERMfT NO.��=� � ' �-�'��`� COMPLETED
ADDRESS \i:��'� � �o-n,��._ �...,, c� �,,_, �v�.J
OWNER �-1� �- ��G���TELEPHONE NO.�=�� - ��`1 -�i��'�"
CONTRACTOR �����--�`�- ������--���
� DESCRIPTION \s����- ����'�"���
t~i� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
y ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINA� ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
� �TIIVAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
J ❑ DEMO-SITE ❑ SEPTIC INSTALL
Z OWNERICONTRACTOR TO MEET 11�U:_YES_NO
ti COMMENTS:
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� ❑WORK SATISFACTORY:PROCEED JECT COMPLEfE
W ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� O CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WFLL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑INSPECTION RE(]UIRED.CALL TO ARRANGE ACCESS.
Ca11 br the next inspection 24 hours in advance. (g52) 249-4600
OwnerlContractor on site: � w <<c
Inspector: i
White Copyllnapecto�'s Fils Canary CopylSite Notice