HomeMy WebLinkAbout2013-01230 - plumbing G � w
CITY OF ORONO * z 0 1 3 - 0 1 z 3 0 *
2750 KELLEY PARKWAY DATE ISSUED: 1U20/2013
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1100 MILLSTON RD
PIN : 10-117-23-14-0015
LEGAL DESC : MILLSTON
: LOT 000 BLOCK 001
PERMIT TYPE : PLUMBING(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURE
NOTE: AREA DRAINS GARAGE
VALUATION OF PLUMBING 2400
APPLICANT PLUMBING FIXTURE FEE 50.00
RIVERSIDE MECHAMCAL STATE SURCHARGE PLBG (VALUATION) 120
12460 ZINRAN AVENUE
SAVAGE,MN 55378- MAIL-IN FEE 2.00
Minnesota State License#: PC644809 TOTAL 53.20
PAID WITH CC# 5399
OWNER
BURWELL, MR. &MRS. RODNEY P
1100 MILLSTON ROAD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
l he work for which this permit is issued shall be performed according to
die approvcd plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due caus .
�vLt�c�� ��i a� i�3 , �L �.� ���Zt�z �� i o7�i ��
Applicant Permitee Signature Date Issue � y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
' � 11/16/2013 08:00 9528947972 LAKESIDE PLUMBING PAGE 03/04
1�OR"G'ITY'liS1;ONLY
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Crystnl f3¢y,MN 553�3 Ap�mvecl JjY: Amaunt$:�' S 3. 2�(�
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-� �• (9,i7.}249-4(i1 G—Pnx "'
y �' CTTX OF OR(�NQ-�'LUMi3�NG PI;RMTT
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���`r��,���`� (All Commercial Permits Mnst bc Approved by thc St�tc PCio1�to C:ily/�pproval)
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GE�i'C;�Ai;�N�'O�.M;�TfC�N .�� � � _ �
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1. You tttay apply 1'or plutnUing permits by miflil or in person At Che City o'[Cccs. npplie�ttions wili bC
reviewed and a perrnit will be issucd within two working day�.
2, Pctmit cards will bc sent by return m�il fli�er a review is complel:ed, PERMITS ARE 1�10�'
VALID UiVTIL YOU RECEfVi; A PCRMIT. W RIC MUST Np'('a�Gi UNTIL Tiili,
P�RMIT CE1,RA IS POSTED ON T�i�.TOB STT�.
3. Plumbing permits may be issued ONLY to Iicer�SCd�lumbing cont't'lctorS Flnd fo pr�perty owncrs
residing in the dwclling.
9. Whcn any ncw construction or remodeling is involved,�.separate buil�iing per�rlil must Uc
ohinined.
5. 11ii work must be dane in accord�nce with 3tate Cade reqt�itcments,
G, nll work musk bC inspcetcd and air tested bCfore it is covered. Call(957.}249-4Gp0,
(24-4$I�our noticc reqnired)
Tv��,o�r.�RMt� �
(Chccic tlll�Th�,t Ap,�1y�' '
(�RcsidenYiai ❑Com�tze��ci�l(Approva!Requirecl)
❑ New (]Additional �RE�11C$ ❑t�eplfloe
❑ fn Accessoiy Structur�7
*�`ou will need praor approvhl and may need CUP.(Per prono City Code,Chapter 78,Article 11')
Jbb 5ite�Owr��r inf'or�r�ttion:
SiCc/lddress: L C�O �dY�: �S��!`�
Owncr: Mailii�g�1,ddress_
C�ity: Cj f�n� _� ,Zip:
Flomc l�hone: Altcrnate Phone:
Centraclor Info��rn�tion:
C:ontractor: ��.�ef S;c� �1Re�.n:«-�" Contact Persoiz: �`c.� '�•.�S Sz l�
Address: !l'-�l04 Z►r�(`4n IA�Q 5tate f3ond ��: ���g��Q l�'�
City, �uJKT__ 7ip�.S�"1`� Lx}�iration�ate: 1 \� � � ...�
Phone: �j SL-4�`��{'--'1���� �1,Iternate Phone: 1�-ct�°7 - 3 Z� '�
Ci�surancc-Current�; �
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1
't' 11/16/2913 08:60 9528947972 LAKESIDE PLUMBING PAGE 04/04
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FIXTURE 8SM7" 1 2 OTH�R RfXTURE BSMT 1• 2 ' OTfiER
TYPr FL FI� TYPr; FL FI.
WaMr Clbsct Floor Drains �
LAVAtory Scwct Ejector
Bathtub Laundry Tray
Shower Wa,sher
Kitclien Sink � Water I lenter
I�IS�)OSflI Water Softener
DISIIWft9I1C� Wet Bar
Sillcocks Misccllancous
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❑ Yes,this scction Rpplies
1'he repincement of anly one Rasidential fixture or applia�tce that meets ali thre�of the following
requirementc:
1, L1oes not requirc modification to electricaJ pr ga,a sorviee.
2. f-la.�a totttl cost�f$500.00 or loss;oxcludinc the cost of the fixture ar sppliance;1nd
3. Is improvecl,inste.11ed or replAeod by Cho homeowner or licensed plt►mbing contractor.
Skip ncxt scction,ifthis applics; Cost ofPennit � 15.00
StatC Surchsrge $ S.QO
Mail-In Fcc(1f Applicahle) $�?.pp
m�tAt r.��r,ir ree $
(Permit Fees Continaccl On Next Pn�c)
2
j ` 11�16/2013 08:00 9528947972 LAKESIDE PLUMBING PAGE 02/04
��;����` .,�����`�'' �'�P'ERIVI�IT;FEE��CAT�CU�ATI�OI�{����'�-TCtI�Si����R�S'�0�0�'.0p ��� � ,�
if�bovc docs not apply;!'ollow guidclines I�elow;
I. CONTRA,C'�'.�'RIC� "' is 1.25"/0 of contract price witl�fl(Nwireimam fcc of�5n.flp)
27�.1'� x.0125 $
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(conU'�Cl priccl (rltinimum S$0.001
2. STA,T�_SUT�Ci�IARGC
,�x.0005 $
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(cnnrr�cl priCc)
3. POS'1'AGE Rt HANDI.ING(Only on Mail-in nppliCElliUns) $ 2,00
a. TOT��,�GRMrT�+��(�dd Li»es 1-3 �.liovc) g
� * CONTRACT PRTCr or .1013 CUST me�ns thc actual or esi.im.ttcd doli�r �»>ount ci�nrged For tiie
per�nitced worlc including materiflls, labor,profit,�.nd oChCr fxed coSts. 1t is the Amount to be cla�rgcd
to the customer for the work done, if tlny m2tcrial, equipment, labor or inst�llations e�•e fin•nished by
the owncr,tcnant�r any other pa�fiy,the re�sonflble marlcet vc�lue oF such it:ettts must be �Iddcd fc�cl�c
CStitnatCd cost or COritfACt �iticc f�r �ermit fec ptirposes. 1n the cvcnt tha.t tl�crc is a dis��utC or tlie
�moune o�f the joU eos�., tl�C Cily may request lhe Subtt�lssion of a siBnCd copy of thc actual con[rflel.
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Tlie undcrsigncd liereby applics to thc Cit:y fo�• issuanec o('a Plu��nbing Permit, a�recs to dc all
wor!< in 5trict accotdancc wicli thc ordin�nces oi'thc Ci1:y ai�d Lhc rcgUlE]t10f1S af tt1C Stfl1r, oi'
Minnesc,ta, and certifics thac all st�l;ements madc on this applioatioi� �rc CC71ll�)�elC, truc and
corrcct.
Applicant's Sign�thrrc: /�-' p11�: <
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