HomeMy WebLinkAbout2015-00977 - plumbing � ' CITY OF ORONO * Z pJ 1 5 - 0 0 9 7 7 *
2750 KELLEY PARKWAY DATE ISSUED: 08/03/2015
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 3484 LYRIC AVE
PIN : 17-117-23-43-0157
LEGAL DESC : NAVARRE HEIGHTS
: LOT MB BLOCK 5
PERMIT TYPE : PLUMBING (<$500)
PROPERTY TYPE : RESIDENTIAL
COI�ISTRUCTION TYPE : FIXTURE
NOTE: WATER SOFTENER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
STATE SURCHARGE PLBG(<$500) 1.00
WATERTOWN PLUMBING TOTAL 16.00
604 HILLSIDE DRIVE NW Payment(s)
WATERTOWN, MN 55388- ��� �S�(� 16.00
(952)255-8212
Minnesota State License#: plbg-PC644088
OWNER
Grady Restoration
760 APPLE GARDEN RD
MINNETRISTA,MN 55364-
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 180 days at any time afrer work has commenced.
The applican[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 Signature Date
FR�M (FRI}JUL 31 2015 8:44/ST, 8;43/No.7517272283 P 1
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a �'Y�I.CF nNti.Y
C�OtOM011O / �v15- ��7�
�� p_p.Box 66 DMrt Renoi �.� Pormrt#
�O 2750 Kclley Parkuray /_ /�
Ckyetal Hsy,MN S 5323 A�pmved By: Amouet S: �`�.`�`-'
(952)2A9�600-Main
� �- (952)24�A616-Fnx
�' �` CITY QF URONO—PLUMBIIVG PERMIT
�'�kesNo��' (All Comnbercial Yermits Mutt be Approved by the State Prior co City Approval)
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GENERAL INFORMA'TION
l. You may apply for plumbing permits by mail or in per�on at the City officec. Aj�{'+licati�nc will he
reviewed and a permit will be issued within two working tlay s.
2. Permit cards will be sent by retum mail after a revicw is completrd. PERMlTS ART'NqT
VALID UNT1L YOU RECEIVE A PERMIT. WORK MC1S'Y'N41'B�GIN UNTiT�THE
PERMiT CARD IS POSTED ON'i'HE JOB SIT�.
3. Plumbing permits may 6e issued ONLY to liccnscd ptumbing conlraclots nnd to pmperiy ownera
residing in the dwelluig.
4. When any new consmiciion or remodeling is involved,a separate buildin$p�rmit mus�bc
obrained.
5. All work must be done in accotdance with State Code requirementR.
6. All work must be inspected and sir tested before it is coverecl, Call(952)249-4600.
(2448 hour notfce requircd)
TXPE OF PERMTT
Check All That A 1
�ltesidential ❑Commercial(Apprc>vat kequired)
�New n Additional [�Repairs ❑Rcplacc
Q In Acccssory S�uctiuc7
*You wili need nrior approVal ana may ncCd CUP.�PCt�TOt10 City COdC,Cht►pter 78,Article iV}
Job Site/4wner�£ormation:
srte Aadress: ��p `� r�c �4�`�
(�r�d ��f�►-��,-
Owner:_ --_� .. _ __ __ . Mailing Address:
City: CJV?,r CJ Zip:
Home Phone: Alt�xnate Phone;
Contractpr Information:
Contractor: �A'���'�`-� ��w'+�'T�Contact Person: �
�
Address: �o Y��d��� State Bond#� L Fo CJ
City: (�t,/1� ��`"'� Zip:�Oa Expiratio�n Date: � � ��
Phone: � -- � � Alternate Phone: �
❑ Insurance—Current:
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FROM 4FR1}JUL 31 2015 8:44/ST. 8:43/No.7517272283 P 2
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l.,r'Yi1K .!t,..N ��. r.�. �'d?i 1 .0 ��. 'Ai�.
FIXTURE BSMT 1' 2 OTHER FIXTURF, BSMT 1 2 �TFTL•:R
TYPE FL FL TYP� �L F�,
Wat,cr Gaset FtoorDrains
Lavatory Scwcr Ejcctor
F�athe,b Laun�dry Tray
Shower T Washer
Kitchen Sinlc Waur HeAter
Disposal Water Sotiener
Dishwas�hcr Wet Bar
Silkocks Mscellamcous
�.�, r,., ,..�..,_ -
,>��L.','��c^r�"�is�;l� h.
�] Yes,this scction appli�s
The rcplaa:meut of a�ly one 12,�sidential lixoiu�e ar appliance that meets all three of the following
requisement,c:
1. Y7oes nat rcquirc modification to elcctrical or gas service.
2. Has a wtal cast of�5500.00 or less;excl ' t�he cost of tht fixture or applia�ce:arud
3. Is improvoed installed or replaced by the homeoumer or licensed plumhing contrac�or.
9kip next section,if this applies: Co�t of Permit S 1S•00
State Surcharge S�,,,Q�
Mail-In Fee(If Applicsbfe) S 2.00
Total Pe�it Fce S
(Perm�Fees Continuod On Neit�a�e)
2
FROM {FRI)JUL 31 2415 8:44/ST. 8;43/No.7517272283 P 3
. . -ti .
If above dces not spply;follow guidetine�bclow:
1. COL�iTBACTPRiCE •is 1.25%of conaract price with a(Mmiuwm Fee ot S30.A0)
x.Q125�
(cana.cc p�ix) (�i��:M)
Z.
X.Q�S s
(�►�IP�+�)
3. POSTAG�dt Fi�1NDI,ING(Only an Msil-In Applications) S 2.00
4. TOTAL P�Rl1�'I'F�E(Add Lines 1-3 Above) �
� '� CONTRACT P'RTCF nr JQR CnSf inean-4 the ectual nr eAtimated dollar amo�t charged for the
penniued work including materials,labor.profi�and other!'ixed costs. It is the amouat to be chuEed
to th�e customer for the work dona If any ma�.erial,eyui�men�labar or irstallations ere furnished by
the ownor,benant or any othar pactq,the ressonabic market value of sueh itertu muat be added tn the
estimated cost or contract pricc for pccmit fce purposes. !n t}�e tvtnt that Ihere is�dispute on the
amount of thc job cost,thc City may rcqucst thc submds9ion of a signed copy of the aecua)eonaect.
���:i��4����;;,�.��'�K ,.�!� � �
The un�ersigned hereby applies tq the City for issuance of a Plumbing Permit, agrees to do all
work in strict accondance with the ordinances of thc City and thc rcgulati�s of the State of
Minnesota, and certifies that all statements made on this application �rc complcte, tru�c and
comect.
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Applicant's Signatare: Dete: �v �
3