HomeMy WebLinkAbout2014-00765 - water softner ,
, CITY OF ORONO * Z 0 1 4 - 0 P1 7 6 5 *
2750 KELLEY PARKWAY DATE ISSUED: 07/24/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952 249-4616
ADDRESS : 2655 NORTH SHORE DR
PIN : 09-117-23-42-0001
LEGAL DESC : UNPLATTED 09 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING(>$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER SOFTNER
VALUATION OF PLUMBING 500
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.25
WATER DOCTORS MAIL-IN FEE 2.00
8201 CENTRAL AVENUE TOTAL 52.25
SPRING LAKE PARK,MN 55432-
(763)535-1800 Payment(s)
Minnesota State License#: mech-WC645002 CREDIT CARD 7603 52.25
OWNER
VAN RIEMSDYK,JAMES
2655 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 Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires sepazate
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 aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
��� / /
Applicant Permitee Signature Date Issued By S' ture ,� i�ate
�/ ��---�
Ju I 21 14 01:02p Water poctors 7635351805 p.2
FOR CITY USE ONi.Y
�o�a Cih�of Orono
P.O_Box 6b Dete Received: Permit�
2750 ICelley Parkx�ay
E C[ystal Bay,AiN 55323 AFproved Bv Amotrt:t a:
i f952)-49-4640—Mair.
� � � ' ;95?)Z49-4616—Fax
c? CITY OF ORONO—PLUMBING PER�1'[IT
�C�`Yf5 kt�R� (�11 Comcnercial Permits yf ust be Approved by the State P�ior to City Appro�al)
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GE�IER,AL 1NFORNIATION
1. You may apply for plumbing permits by mail er in person at the City offices. Applications w�ill be
reviewed and a permit will be issued within hvo working days.
2. Permit cazds urili be sent by return mail after a review is completed. PER:YIITS ARE NOT
VALID UN'TIL YOU RECEIVE A PER1�t1T. WORK MUST NOT BEGiN UNT'[L THE
PERMlT CARD IS POSTED OI�T THE JOB STTE.
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 invoh�ed,a sepacate building permit must be
obtained.
5. Ali tt�or's must be done in accordance with State Code requirements.
6. All urork 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 lv
�Residential ❑Commercial(Agproval Requircd}
�New ❑Additional ❑Repairs ❑Replace
❑ In Accessory Structure?
*You will need arior aaaroval and may need CUP.(Per Orono City Code,Chapter'18,Article IV)
7ob Site/Owner.Inforrnarion; -
Site Address: ���J�' /�d�rH s hfD/�� 1�/2�U LJ
Owner: Mailing Address:
Ciry; Zip:
Home Phone: Altemate Phone:
Contractor Information:
Contractor:W A`�''��R� Contact Persan: ���V � C �-!��JlN�
Address:f3a0(e�^`T2A-1 Y�t-VL State Bond TM: �� �����Z
City:5l�J�i�i L�E �1��- Zip:.S��Expiration Date:
Phone: 7�3-"53S�1&� Altemate Phone:
❑ Fnsurance—Current: �� �
l
Jul 21 14 01:03p Water poctors 7635351805 p.3
. . ..
'' =� �?�.�J�IBI�tl3�F�T�J�t.E�'°�3�7G`�1'ST�-4L�E� - ' `
FIXTURE BS_l�iT 1� 2 07'HER FIXTURE BS1+1T 1 2' OTHER
TYPE ' FL FL TYPE FL FL
ti`'ater Closet Floor Drains
Lavatory Sew�er�jector
Bathcub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener �
,
Dishwasher Wet Bar
Sillcocks 1�Tiscellaneous
� � ' -�ER1V1[T FEE C}�.�,CCI�,ATIOrT(S) - :
: B�i�.ED C7t��>:-?A02':ST.�1T�5'T1�"I"[JE
❑ Yes,this section applies
The replacement of oniy one Residential fix[ure or appliance that meets all three of the followin�
requirements:
l. Docs not require modification to electrical or gas service.
2. Has a total cost of$�00_00 or]ess;excludine the cost of the fixture or appliance:and
3. Is irnproved,installed or ieplaced by the homeowner or licensed plumbing contractor.
Skip next section,if tl�is applies; Cost of Permit $ 15_00
State Surcharge $ 5.00
Ivlail-In Fee(If Applicable) $ 2•00
'Iotal Permit Fee S
(Permit Fees Continued On Next Page)
2
Jul 21 14 01:03p Water poctors 7635351805 p.4
= - : . ,��.�-������,cuL�xzo�. s,=�oss r���sao;a� .. - :
If aboa•e does not apply;follew guid2lines below:
1. CO�iTR.ACT PIZICE *is 1.25%of contract price�e�ith a(Minimum Fee of$50.00)
� t � o xA225S V'�Q� � Q
(cantract price) (miaimum S50.00)
2. STATE SURCHARGE �a S�
x.0005 $
(contract price)
3. POSTAG�&HAI�DLING(On1y on 1�1ai1-In Applications) $ 2.00
4. TOTAL PERM[T FEE(Add Lines I-3 Above) $ J��, ��
■ * CONTRACT PRICE or JOB COST mcans the actual or estimated dollar amotar[ charged for ttie
permit�ed work ineluding materia(s,]abor,profit,and other fixed cost.s. It is tne amount to be charged
to the customer for the �Nork done. Cf any material, equipment,labor or installations are furnished b;�
the owner,tcnant or any other party, the reasonab)e market value of such items �nust be added to the
estimated cost or contract price for permit fee purposes. In the event that chere is a dispute on the
amount of the j�b cost, the City may request the submission of a signed copy of the actual contract.
_ ,., : . .
. _. , ,. ..; p�,i�N18J1�i�''.x FEI�.�v1I'I'�PP�;xi�ATIC�1�1:.t�GREENl�.l�� :,. . .: .
The under:igned hereby applies to the City for issuance of a Plumbing Permit, agrees to do a11
work in strict accordance with the ordlnances 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: /��'�� � �
3