HomeMy WebLinkAbout1996-008374 - pvb backflow prevent PERMIT
� CITY OF ORONO
PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 Permit Number: �`�_���'�%���`�`�`
Crystal Bay, Minnesota 55323 `-�",.-'�`�
(612)473-7357 Date Issued: �_},��� h,;^;�r, i
SITE ADDRESS:
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FEE SUMMARY:
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APPLICANT/PE ITEE SIGNATURE ISSUED BY:SIGNATURE
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C1TY OF UIt.ONO APPLICATION FOR PLUMBING P�RMIT
Box 66 (27�0 Kelley Parkway)
Crystal Say, MN 55323
GENF,RAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City offices.
2. Permit 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 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 the State Code requirements.
6. All work must be inspected and air tested before it is covered. Call 473-7357. 24-hour notice required.
Instruction,� Complete all items on this application. Compute the permit fee. Sign and date
the certification. INC01�9?LET� APPLICATIONS WILL NOT BE PROCESSED. If you have
questions, call 473-7357.
Please check one: New � Addition Repair Replace
� Residentia Commercial
JOB SITE• /�D c'1 �/ /��� �1� Zip:553�G
Owner's Name: .o y S�,/l�',�?�m( Telephone Number: 73��O
Mailing Address: �p l ��'�l ,v City:��/��l_,¢,�'�� Zip:_�5�5'G
Contractor'sName: �'�� TelephoneNumber:
MailingA ddress: City: Zip:
PLUMBING FIXTURE SCHEDULE
FIXTURt: 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
Dispos.il Water Softener
Dishw.�sher Wet Bar
Sillcocks Misc (list) .
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PERMIT FEE CALCULATION
1. 1.25% of Contract Price* or Minimum Fee ($35.00)
;��;C� x .0125 $
(contract price)
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit. x .0005 $ s��
(contract price)
or $.50, whichever is greater
3. Postage and Handlin� (Only mail-in applications) $ ��
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ,�i5 d
* 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
cusromer 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 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 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 Inspectional 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.
Applicant's Signature:�G� - Date: � �a ��
DATE TIME �
CITY OF ORONO CALLED IN �1/�'''�
INSPECTION NOTICE scHE�u�Eo �-f i� �`���
PERMIT NO. -�/� J COMPLETED _� ��
ADDRESS /7 � � �'�-� ���'' �l� ��
OWNER �.Q.��=-�-�-� c� CONTR. d,��-1�r/��_ ���Y�
TELEPHONE NO. � 3 � ' ��� �'`�
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� DESCRIPTION ������� L�-' �i�-i��'L- -��z
� 01 FOOTINa 11 MECHANICAL RI 18IXCAV/GRADIN(i/FIWN(i
� 02 FRAMING 13 MECHANICAL FINAL 19 LAI�SHOREJWETLANDS
Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z pq yyq�,L gp. 12 WATER HOOK-UP 17 SITE INSPECTION
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2 OS FINAL 14 SEWER HOOK-UO 06 PROGRESS
~ 07 DEM�SITE 27 SEPTIC MAINT. 21 COMPLAINT
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Q 07 DEMO—FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RL 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 70 PLUMBINO FINA�L 36 FOUNDATION REMOVAL
Z\ DWFIER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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d WORK SATISFACTORY:PROCEED - PROJECT COMPLETE
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WL CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑ CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. r- pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR
C CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the ne t i,spection 24 hours in advance.473-7357
OwnerlContra o n s :
Inspector.
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