HomeMy WebLinkAbout2014-01147 - plumbinf � •..
� CITY OF ORONO
2750 KELLEY PARKWAY * z 0 1 4 - 0 1 1 4 7 *
DATE ISSUED: 10/06/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3818 NORTH SHORE DR
PIN : 08-117-23-34-0064
LEGAL DESC : CRYSTAL BAY VIEW
: LOT MB BLOCK MB
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURE
NOTE: REPLACE DISHWASHER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
STATE SURCHARGE PLBG(<$500) 5.00
MN PLUMBING&APPLIANCE INC. MAIL-IN FEE 2.00
14105 RUTGERS STREET NE TOTAL 22.00
PWOR LAKE,MN 55372-
(952)469-8341 Payment(s)
Minnesota State License#: cont-58455-PM CHECK 1316 22.00
OWNER
JOHNSON, PAULA
3818 NORTH SHORE DR
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee ignature Date Issu By Signature Date
/
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$�� City of Orono � `I USE ONLY
r 0 e � P.O.Box 66 I�be Receiv�D Pertitit# / �� ���
2750 Kelley Parkway
i� � :�::.� Crystal Bay>MN 55323 Approved By: Amount S:
L_ (952)249-4600—Main
"� (952)249-4616—Fax
CITY OF ORONO-PLUMBING PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
htt ://www.dli.mn. ov/CCLD/PDF1 e lumb lanreva , df
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 cazds will be sent by return mail after a review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BE IN UNTIL THE
PERMIT CARD IS POST D ON TAE JOB SITE.
3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property ov►mers
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 State Code requirements.
6. All work must be inspected and air tested before it is covered. Call(952)249-4600.
(2448 hour notice required)
TYPE OF FERMI'f
Gheck AlI That A 1
�Residential ❑Commercial(Approval Required)
❑New ❑Additional ❑Repairs LbI Re lace
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❑ In Accessory Structure?
*You will need orior a�oroval and may need CLJP.(Per Orono City Code,Chapter 78,Article IV)
Job Site/Owner Information:
Site Address: ��� IVTj✓�1 �G �'I V-�
Owner:�G�,c�C.� ��Y-�� Mailing Address:
City: Zip:
Home Phone: �Z-�-I�I-9�� Alternate Phone:
Contractor Information:
Contractor: Ml� IUi�h�l�l -� `jQ�ontact Person: �UC,+'�I (�
Address: � ( i-IV� State Bond#: rJS�i55-P/'1
City: �l'IpY Zip: �J3�ZExpiration Date:
Phone: �52-u�oG! `FS3� 1 AlternatePhone:
❑ Insurance-Current:
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FIXTURE BSMT 1 2 OTHER FIXTURE BSMT l 2 OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower W��
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher W�g�
Sillcocks Miscellaneous
❑ Yes,this section applies
The replacement of only one Residenrial fixture or appliance that meets all three of the following
requirements:
1. Dces not require modification to electrical or gas service.
2. Has a total cost of$500.00 or less;excludin¢the cost of the fixture or appliance:and
3. Is improved,installed or replaced by the homeowner or licensed plumbing contractor.
Skip next section,if this applies; Cost of Permit $ 15.00
State Surcharge $ 5.00
Mail-In Fee(If Applicable) $ 2.00
Total Permit Fee S 22��
(Permit Fees Continued On Next Page)
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If above does not apply;follow guidelines below:
1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00)
x.0125$
(contract P��) (minimam 550.00)
2. STATE SURCHARGE
x.0005 $
(c;onvact price)
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
■ * 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 done. If any material,equipment,labor or installations are fumished by
the owner,tenant or any other pazty,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 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: q�7A ��LI
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