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CITY OF ORONO * Z 0 1 4 - 0 P1 7 PJ 5 *
2750 KELLEY PARKWAY DATE ISSUED: 07/09/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1575 MAPLE PL
PIN : 08-117-23-33-0032
LEGAL DESC : CRYSTAL BAY VIEW
: LOT O10 BLOCK 006
PERMIT TYPE : PLUMBING(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURES-MULTIPLE
NOTE: (4)WATER CLOSETS,(6)LAVATORIES,(2)BATHTUBS,(2)SHOWERS,(1)KITCHEN SINK,(1)DISPOSAL,(1)DISHWASHER,(2)
SILLCOCKS,
(1)FLOOR,(1)WASHER AND(1)WATER HEATER
VALUATION OF PLUMBING 13000
APPLICANT PLUMBING FIXTURE FEE 162.50
STATE SURCHARGE PLBG(VALUATION) 6.50
NORTH ANOKA PLUMBING MAIL-1N FEE 2.00
22590 RUM RIVER BLVD.N.W.
MN 55070- TOTAL 171.00
(763)753-3373 Payment(s)
CHECK 18652 171.00
OWNER
Maple Place LLC
550 25TH AVE N
ST. CLOUD,MN 56303-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
�`�r� 7 / Cl l/
Applicant e rtee Signature Date Iss d By Signature Date
FO CI LJSE ONLY
/ City of Orono
/ �ON\ P.O.Box 66 Date Receiv� � Permit#� 7�
� � 2750 Kelley Parkway
rV Crystal Bay,MN 55323 Approved By: Amount$:�L�%
� � (952)249-4600—Main
�' � (952)249-4616—Fax
���` �� CITY OF ORONO-PLUMBING PERMIT
��kE�sH���� (All Commercial Permits Must be Approved by the State Prior to City Approval)
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GENERAL INFORMATION
L 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. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECENE A PERMIT. WORK MUST NOT BEGIN UNTIL THE
PERMIT CARD IS POSTED ON THE JOB SITE.
3. Plumbing permits 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 permit 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 prior apnroval and may need(_L P.(Per Orono City Code,Chapter 78,Article N)
Job Site/Owner Information:
Site Address: , �� � �f/��1n�,e �'n,,C e,
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: � • `�,,��¢ 1')u v,��•L� C ntact Person: I �v eh�CNl�s=r,-n
N tr-�
Address: 2Z�`l U 12�.,-,.,,,12...�',,�e..., 13�,Q State Bond #: �C lp y Z 8 � �{
City: � .�Vu-ti.c.,S Zip: �7vExpiration Date: 1�-`"3 \� ��
Phone: �1 l�3 - 7 S 3 -3 3�1 � Alternate Phone: lD I`L --l, l�i - �l 0 3 �1
❑ Insurance-Current:
1
FIXTURE BSMT 1 2 OT'I�R FIXTURE BSMT 1 2 OTI�R
TYPE FL FL TYPE FL FL
Water Closet 1 � Floor Drains i
�
Lavatory i ` , f Sewer Ejector
( � �..1
Bathtub � Laundry Tray
Shower I ( Washer (
Kitchen Sink ' Water Heater f
Disposal Water Softener
Dishwasher Wet Bar
�
Sillcocks ,Z Miscellaneous
❑ Yes,this section applies
T'he replacement of only one 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;excludine the cost of the fi�cture or appliance:and
3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee $
(Permit Fees Continued On Nezt Page)
2
' If above does not apply;follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
`� O� O X.oias$ � ( �2--�0
(cc tract price) (minimum$50.00)
2. STATE SURCHARGE �
O� x.0005 $ �o • ,�
(c ntract price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �� ( , � b
■ * 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 installations 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 permit 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 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 al statements made on this application are complete, true and
correct.
Applicant's Signature: ` lC.l� Date: � — g � � y
3
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CDATE TIME �'�j�
�ITY OF ORONO CALLED IN
INSPECTION N�OiTICE// SCHEDULED � �11
PERMIT NO. /1�� 7 `�7��COMPLEfED
ADDRESS �5 7� ��-�lZ(D �/� .
OWNER TELEPHON NO.���Z �a��S
CONTRACTOR ��� ��d/LC} �/fam.�
� DESCRIPTION ��� u"a" ( ` /�"��
W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
_
v ❑ DEMO-SITE PTIC INSTALL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET YOU: ' YES_NO
� COMMENTS: �—
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0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECWERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL REfURN
�STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
caF[�_ T�_REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 forthe next inspection 24 hours in advance. (952� 249-460�
OwnerfContractor on site:
�
Inspector.
White opyllnspector's Ffle Cenary CopylSite Notice
� C� DATE TIME ��/
CITY OF ORO O CALLED IN ,��_� "
INSPECTION OTIC�f� CHEDULED 3!9�� /D.�d
PERMR N��5"' �7�� PLETED
ADDRESS S7 � / L �- �-
OWNER _ T EP NO. a� -�75
CONTRACTOR a• � �
� DESCRIPTION v� "
t~y ❑ FOOTING ❑ DEMO- AL ❑ SEPTIC FINAL
� ❑ POURED WALL �UM ING RI ❑ EXCAV/GRADING/FILLING
❑ FOUNDATION WATERPROOF UMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
� ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
� ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
J ❑ DEMO-SITE ❑ SEPTIC INSTALL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRIICTOR TO MEEf YOU:_YES_NO
c�.� COMMENTS:
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V BEFORE CONERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cail for the next inspection 24 hours in adva . 9 -46��
OwneHContractor on site:
Inspector:
White Copyllnspector's Flle Canary CopylSfte Notke
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r ,� DATE TIM�
U CITY OF ORONO CALLED IN
INSPECTION NOT E SCHEDULED i� �n
PERMIT N '- '� U� COMPLETED
ADDRESS � ��`-� ��-2 t''��
OWNER TELEPHONE NO�O�Z "(���i "703�
CONTRACTOR �� `��`�0'`�� �� � �
� DESCRIPTION V�S 0.Q � I�Q��. ���
W ❑ FOOTING ❑ DEMO-FINAL ❑ S P IC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
v ❑ DEMO-SITE ❑ SEPTIC INSTALL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO �
c�.� COMMENTS: � ���
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O ❑CORRECT WOHK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cali for the next inspection 2a hours in advance (g52) 249-4600
OwnerlContractor on site:
Inspector.
White Copyllnspector's File Ca ry CopylSite Notice
/ �� �i"��V
� D,yTE TIME
CITY OF ORONO CALLED IN C�:��3—��'; /
INSPECTION N ICE SCHEDULED �� f��
PERMIT NO. ��5 COMPLETED '
ADDRESS �J� 7 �
OWNER TEL PH � NO. � � � �
CONTRACTOR �• Q C
� DESCRIPTION
ty ❑ FOOTING ❑ DEMO- I AL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUM IN RI ❑ EXCAV/GRADING/FILLING
Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
_ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
J ❑ DEMO-SITE ❑ SEPTIC INSTALL
2 OWNERICONTRACTOR TO MEET YOU:_YES_NO
c�., COMMENTS:
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0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECWERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN
INSPECTOR WILL REfUHN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS_
Call for the next inspection 24 hours in advance. (952 j 9-46��
OwnerlContractor on site:
Inspector.
White Copylinspector's File Canary Copy/Site otice