HomeMy WebLinkAbout2010-00191 - water heater ,
CITY OF ORONO PERMIT NO.: 2010-00191
' 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 04/06/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 1465 LONG LAKE BLVD
PIN : 35-118-23-22-0005
LEGAL DESC : REG. LAND SURVEY NO. 1379
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER HEATER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
NORBLOM PLUMBING CO. STATE SURCHARGE PLBG (<$500) 0.50
2905 GARFIELD AVENUE S.
MINNEAPOLIS, MN 55408- MAIL-IN FEE 2.00
(612) 827-4033 MISC FEE 0.00
TOTAL 17.50
OWNER
VANDERBRANDEN, ERIC
1465 LONG LAKE BLVD
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of I80 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cauye.
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Applicant Permitee Signature Uate Issued By i nature Date
SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E.
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/ ' � O,¢p�Oi City of Orono ' , .., �
P.O.Box 66 Datc�ecaived' � Perrn�t# �
2750 Ke11ey Parkway < i ,
, � �+ Crystal Bay,MN 55323 Ap,pro'ued B� ,t��aunt$
G' 952 249-460 er„, � ^ ju `A'g'� ,
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CITY OF ORONO—PLUMBING PERMIT
(All Commercial permits must be approved by the Building Official or Inspector)
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'CrEI�TE. -'INFO':.R���'ZOl*7 � ,f,,.
1. Youj may apply for plumbing pemuts by mail or in person at the City offices. Applications 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. PERMITS ARE NOT
VAL1 ID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON�TAE JOB SITE.
3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to properly owners
residing in the dwelling.
4. When any new cons�uction or remodeling is involved,a separate building perxnit 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)
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�Residential ❑ Commercial(Approval Required)
❑New ' ❑Additional ❑Repairs �Replace
❑ In Accessory Structure?
*You will need prior anuroval and xnay need CUP.(Per Orono City Code,Chapter 78,Article IV)
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Site Address: _ Donald Lund
;
, 1465 Long Lake Boulevard
Owner: Orono, MN 55356 .ddress:
, 9524737450
City:
Home Phone: Alternate Phone:
'�Contra:ctar,fiii�ormation:, '
Contractor:l'�
�l�rblorn PU,u�YLb�� Contact Person:
Address: ' 2��� �lQ�l�1��d �V sti, State Bond#: ���_J� �
City: ; �. �S Zip�b$ Expiration Date: I I v�I� 1
! ��r�-)82?- �{a33 --
Phone: i� Alternate Phone:
� � Insurance—Current:
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FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejectar �
Bathtub Laundry Tray !
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Shower Washer I
Kitchen Sink Water Heater I 'i
Disposal Water Softener '
Dishwasher Wet Bar
Sillcocks Miscellaneous I
❑ Yes,this section applies II
The replacement of a Residenrial fixture or agpliance that meets all three of the following reqi4irements:
1. Does not require modification to electrical or gas service.
2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:;and
3. Is improved,installed or replaced by the homeowner or licensed contractor.
Skip next section,if ttus applies; Cost of Pernut $ ' 15.00
State Surchaxge $ , .50
Mail-In Fee(If Applicable) $ � 2.00
Total Permit Fee $�
(Permit Fees Continued On Negt Page) ,
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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$50.00)
x.0125$
(contract price) (minimum$50.00)
2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50)
x.0005 $
(contract price) (minimum$ .50)
� 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. T,OTAL PERMIT FEE(Add Lines 1-3 Above) $
■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
pernutted 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 installations aze furnished by
the owner, tena.nt or any other party, the reasonable market value of such items must be added to the
estimated cost or contract price for permit fee putposes. 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 valuations over$1,000,000 call the Building Department at(952)249-4600 for the price.
T'he 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 ma.de on this application are complete, true and
correct.
Applicant's Signature: Date: / (
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