HomeMy WebLinkAbout2015-00171 - plumbing CITY OF ORONO * 2 0 1 5 - 0 0 1 7 1 *
� 2750 KELLEY PARKWAY DATE ISSUED: 02/10/2015
t ORONO, MN 55356-
(952 249-4600 FAX: (952 249-4616
ADDRESS : 645 NORTH ARM DR
PIN : 06-117-23-43-0012
LEGAL DESC : REG. LAND SURVEY NO. 1508
: LOT 000 BLOCK 000
PERMTT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER HEATER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
STATE SURCHARGE PLBG(<$500) 5.00
CROIX CRYSTAL MAIL-[N FEE 2.00
3440 YOERG DR TOTAL 22.00
HUDSON, WI 54016-
(715)386-8667 Payment(s)
CHECK 13389 22.00
OWNER
SHIN,KWANG&BARBARA
645 NORTH ARM DR
MOUND,MN 55364-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issued By Signature Date
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FOR CITY USE ONLY
City of Orono � ��,�G� ��
• % �O� P.O_Box 66 Date Received: EY_"_'*,�_ Permit#
;'�� . �l'` 2750 Kelley ParkwaY �}
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�,i,� i;>`r•� F�� C stal Ba ,MN 55323 Approved By: � Amount$: �Z
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''; t�� �� �o`,' (952)249-4600—Main
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CITY OF ORONO— PLUMBING PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
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GENERAI,INFORMATION
1. You may apply for plumbing pemuts by mail or in person at the City offices. Applications will be
reviewed and a pennit will be issued within two working days.
2. Permit cards will be sent by retum mail after a review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL TI-IE
PERMIT CARD IS POSTED ON TI-IE JOB STTE.
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 separate building peimit 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
�2esidential ❑Commercial(Approval Required)
❑ New ❑Additional ❑Repairs �Replace
❑ In Accessory Structure?
*You will need nrior aparoval and may need Ct_1P. (Per Orono City Code,Chapter 78,Article I�
Job Site/Owner Information:
,
Site Address:
Owner. Mailing Address: �
City: ���� Zip:
�
Home Phone: � � Alternate Phone: ������
Contractor Information:
Contractor: �Lc�C Contact Person:
� �
Address: , State Bond#:
City: Zip4��Expiration Date:
Phone: ���� OlolD� Alternate Phone: l�� T'7 �'7"7 1 _
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❑ Insurance—Current: j'�12f)��'�
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PLi'IM�ING FIXTURES BEING INSTALLED
FIXTURE BSMT 1 2 OTI�R FIXTURE BSMT 1 2 OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Wa��'
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous
P RMIT`FEE CALCULATiON(S) ,
B SED OFF - 2002 STATE STATUE
❑ Yes,this section applies
The replacement of only obe 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;excluding the cost of the fixture or appliance: and
3. Is improved,installed or replaced by the homeowner or liceiised plumbing contractor.
Skip ne�section,if this applies; Cost of Pemut $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
,
, Total Permit Fee `$�
(Permit Fees Continued On Neat Page)
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. •
PER1VfIT FEE CALCULATION S -JOBS OVER$500.00
If above does not apply;follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
x.0125$
��a�t�;�> c�,io��sso.00�
2. STATE SURCHARGE
' x.0005 $
(contract price)
3. POSTAGE 8r HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
■ * CONTRACT PRI�E or JOB COST means the actual or estimated dollar amount charged for the
pennitted work incl�iding materials,labor,proft, and other fixed costs. It is the amount to be charged
to the customer for t�e work done. If any material,equipment,labor or installations are fumished 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.
PLUMBING PERNIIT APPLICATION AGREEMENT
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.
Applicant's Signature: �� Date: G
,�
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