HomeMy WebLinkAbout2016-01140 - water heater CITY OF ORONO �2 0 1 6 - 0 1 1 4 0 *
� � . 2750 KELLEY PARKWAY DATE ISSUED: 09/19/2016
ORONO,MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2060 NORTH SHORE DR
PIN : 10-117-23-31-0003
LEGAL DESC : iJNPLATTED 10 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER HEATER
NOTE: REPLACE:WATER HEATER
VALUATION OF PLUMBING 1607
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.80
UPTOWN HEATING&COOLING MAIL-IN FEE 2.00
3110 WASHINGTON AVE.N.
MINNEAPOLIS,MN 55411- TOTAL 52.80
(612)827-4674 Payment(s)
CHECK 38440 52.80
OWNER
GODFREY,LYLE&NORMA
2060 NORTH SHORE DR
WAYZATA,MN 55391-
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 Bui(ding Code. This permit is for only the work described and dces
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
! ' ' �p,� City of Orono FOR CITY USE O LY
O P.O. Box 66 Date Received: L1-( �`��G
,�111 2750 Kelley Parkway ;�
� � Crystal Bay, MN 55323 Permit# �-,,�����'�=�� �� �,l
F (952)249-4600-Main
��`"�����' (952)249-4616-Fax Approved By: �� ,
Amount$:
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CITY OF ORONO — PLUMBING PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
http://www.dli.mn.qov/CCLD/PDF/pe plumbplanrevapp.pdf
GENERAL INFORMATION
1. 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 RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS
POSTED ON THE JOB SITE.
3. Plumbing per�nits may be issued ONLY to licensed plumbing c�ntractors and to property o�vners
residing in the dwelling.
4. When any new construction or remodeling is involved, a separate building permit must be obtained.
5. Ali 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 Apply)
�Residential ❑ Commercial (Approval Required) [�3ackflow �evice: ❑ Av�3 ❑ t�vB]
❑ New ❑ Additional ❑ Repairs �Replace
❑ In Accessory Structure?
*You will need prior approval and may need CUP. (Per Orono City Code, Chapter 78, Article IV)
Job Site / Owner Information:
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Site Address: 1�-u�� ��i ;�'
Owner:_���'L �������� Mailing Address: ��l"� ��i::;'�� ���� '�C���
City: �7�om1.� � Zip: ���� t
Home Phone: � C�;����(o���'��Iternate Phone: i
Contractor Information:
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Contractor: (�!1 D ��'o��^ ��� Contact Person: u� � , '1�
Address: "���� �a-�^�"�,�t��i�, ��� � State Bond #: `" 1 «J�"`��
City: /�1'1\� ��� a '. ' � Zip: S � � Expiration Date: � �� �� �� �
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Ph e: So t��' ���� "�Z� Alternate Phone: �
' Insurance — Current: ��°���'����
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PLUMBWG FIXTURES BEING INSTALLED ' ` i
FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 1sT 2ND OTHER
TYPE Floor Floor TYPE Floor Floor
Water Closet Fioor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater �
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous
PERMIT FEE CALCULATION
1. CONTRACT PRICE " is 1.25% of contract price with a (Minimum Fee of$50.00)
���� x .0125 $ ��'� ��L
(contract price) (minimum $50.00)
2. STATE SURCHARGE
l (>l� � x .0005 $ v� �v
(contract price)
3. POSTAGE 8� HANDLING (Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ �� t ��-'
" 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 d�ne. If a�y materiai, equi��nent, laoor or instaliations are furnisnecf 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 PERMIT APP`LICATION 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 t is application are complete, true and correct.
ApplicanYs Signature: + Date: �� ' l =' J � �v
Building Official/ Inspector: Date:
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