HomeMy WebLinkAbout2017-00138 - water softner ' � CITY OF ORONO * 2 0 1 7 - 0 0 1 3 8 *
2750 KELLEY PARKWAY DATE ISSUED: 02/14/2017
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 4470 NORTH SHORE DR
PIN : 07-117-23-31-0010
LEGAL DESC : BERGQUISTS 2ND ADDN TO SAGA HI
: LOT 004 BLOCK 000
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURE
NOTE: WATER SOFTENER
VALUATION OF PLUMBING 500
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.25
CULLIGAN SOFT WATER SERVICE CO. MA[L-IN FEE 2.00
6030 CULLIGAN WAY
MINNETONKA,MN 55345- TOTAL 52.25
(952)912-7379 Payment(s)
CREDIT CARD 5107 52.25
OWNER
ETAL,JOHN GROTANS
4470 NORTH SHORE 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 goveming this rype 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 I 80 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 B ignature Date
02/14/2017 08:57 FAX 9529335049 CULLIGAN MNTKA �002
�p� city ot orono �ECEIVEU ' Fa�c USE, NL
Date Received: � '���
� P.O. Box 66 ,,... , . ;
� 2750 Kelley Parkway ��� � ,� 2017 Permit# �`
,��' � Crystal Bay, MN 55323
(952)249-4600--IJ{ain A p�oved B
t�kFSHOR� (g52)249-4fi16—Fax Cr�N OF OR�NO p„ y ` �_ t� '
Amount$.
CITY OF ORONO—PLUMBING PERMIT
(Ali Cornmercial Permits Must be Approved by the State Prior to City Approval)
htt :/lwww.dli.mn. ov/CCLD1PDF/ e lumb lanreva . df
GENERAL:WFORMATION , '. ,. ; � .
1. You may apply for plumbing permits by mail or in person at the City offices. Applications will be
reviewed and a permit wilf be issued within two working days.
2. Permit cards will be sent by return mai! after a review is compieted._PERMI7S ARE NOT VALID
UNTIL YOU RECEIVE A FERMIT. WORK MUST NOT BEGIN UNTtL THE PERMIT CARD !S
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 invofved, 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,
(24-48 hour notice required)
,
,
�^' '° ' TY;PE OF:'PERMIT(Ch�eck AIf That:Apply) „ ' -
,[�Residential ❑ Commercial (Approval Required) [Backflow Device:�AVB ❑PVB]
�New ❑Additional ❑ Repairs ❑ Replace
❑ ln Accessory Structure?
*You wiN need prior approval and may need CUP. (Per Orono City Code, Chapter 78, Artide f�
Job 5ite / Ownei'Information:`
Site Address: yy 1 � i� s�0'� �� -
Owner: �a�,�. ��v� S Mailing Address:
City: Zip:
Home Phone: `�S�—�`1�3 — �� bU Alternate Phone:
Contractor fnfo�mation:
Contractor: INGtact Person:
6030 CULLEG�,N 1NAY State Bond #:
Address: �
C� . (952) 933-7200 Z�p; Expira#ion Date:
tY
Phone: Alternate Phone:
❑ {nsurance— Current:
Page 1
02/14/2017 08:57 FA% 9529335049 CULLIGAN ffiVTKA 1�003
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FIXTURE BSMT 1� 2ND OTHER FIX�TrPEE BSMT ��oor Floor OTHER
1YPE Floor �loor
Water Closet Fioor Drains
Lavatory Sewer Ejector .
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposa! Water Softener �
Dishwasher Wet Bar
Sillcocks M9sceflaneous
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1. CC1AfTRACT PRICE * is 1.25%of contract price with a (Minimum Fee of$50.00)
�'p O. �� x .0125 $ J�O. ��l
{confract price) (minimum $50.00)
�2. S7ATE SURCHARGE
x.0005 $
(contract price)
3. P05TAGE 8 HANDL[NG (Oniy on Mail-1n Applications) $ 2.00
4. 70TAL PERMIT FEE (Add Lines 1-3 Above) $ �
* CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
permitEed work including materials, labor, profit, and other fixed costs. it is the amount to be charged to
the custamer for the wark done. If any matecial, equipment, labor or installations are fumished 6y the
owner, tenant or any other party, the reasonable market vafue of such items must be added to the
estimated cost or contract price for permit fee purpases. In.the event tha# there is a dispute on the
amount of the job cost, the City may request the subm9ssion of a signed copy of the actual contract.
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The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do al1 work in
strict accordance with the ordinances of the City and the regulations of #he State of Minnesota, and
certifies that all statements made on this application are complete,true and correct.
ApplicanYs Signature: Date: c�� �y ' �7
Building Official/Inspector: Date:
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