HomeMy WebLinkAbout2001-P04511 - vacuum breaker PERMIT
C�TY-OF ORONO Permit Number:
27v�0 Kelley Parkway - PO Box 66 Poas�i
Crystal Bay, Minnesota 55323 Permit Type: vacuum Breaker
(952) 249-4600 Date Issued: loii9i2ooi
SITE ADDRESS: 165 Luce Line Ridge
Maple Plain,MN 55359
PID: 31-118-23-34-0008
DESCRIPTION:
Proposed Use: Kesidential
Permit Class: Plumbing
Permit Type: Vacuum Breaker Permit Sub-type(s): Vacuum Breaker
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Vacuum Breaker
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 500.00
State Surcharge Fee: $ 0.50
Misc. Fee: $ 1.50
TOTAL FEE: $ 37.00
APPLICANT: �'�'eld& Sons Plumbing OWNER: Mr.&Mrs. Church
315 Juneau Lane 165 Luce Line Ridge
Plymouth,MN 55447 Maple Plain MN 55359
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.
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APPLICANTPERMITEESIGNATURE ISS EDBYSIGNATURE
Copies: 1-File(SiQnitures Required). 1-Applicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
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CITY OF ORONO APPLICATION FOR PLUMBING PERMIT
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City offices.
2. Pernut 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 CARD IS
POSTED ON THE JOB SITE.
3. Plumbing pemuts 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. Call 249-4600. 24-hour notice required.
Instructions Complete all items on this application. Compute the permit fee. Sign and date
the certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have
questions, call 249-4600.
Please check one: New Addition ;�'/Repair Replace
�- � Residential Commercial
JOB SITE: ��u� ���:� l ��e �� ��E' Zip:
Owner's Name: �� ���z-� Telephone Number: �,/,;Z -_3o,S�-. 7�j���,Z
111ailing Address: �6:SS �t��� L i n�, �'����City: U�--G r�� Zip:�
Contractor's Name: �%fr� �- ��HJ3 �u;� Telephone Number: �,y3- y75�c��fr;
Mailing Address: �3l_5' Tr�✓��ct., l�<;�C, City: � ,�,��,�1 f� Zip: .�:��y�
PLUMBING FIXTURE SCHEDULE
FIXTURE BSMT 1ST 2ND 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
Dishwasher Wet Bar
Sillcocks Misc (list) j�Q �,�� r,v�
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PERMIT rEE CALCULATION
1. 1.25% of Contract Price* or Minimum Fee ($35.00)
x .0125 $ � ;�, ��C�
(contract price)
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit. x .0005 $ ,�C�
(contract price)
or $.50, whichever is greater
3. Postage and Handling (Only mail-in applications) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��;, ����
* CONTRACT PRICE or JOB COST means the actual or estimated 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 installation 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 pernut fee purposes. In the event that there is a dispute on ti-�e a�-nount of the jeb ces!,
the Cicy 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 Department of Jnspectional 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 are complete, true and
correct.
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Applicant's Signature: �.--= i���— Date: J�� %6 a