HomeMy WebLinkAbout2014-01426 - plumbing • CITY OF ORONO 0110111111110 1 1 III 10 H
2750 KELLEY PARKWAY DATE ISSUED: 12/12/2014
ORONO, MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 825 OLD CRYSTAL BAY RD S
PIN : 09-117-23-21-0001
LEGAL DESC : UNPLATTED 09 117 23
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING(<$500)
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURE
NOTE: WATER SOFTENER
APPLICANT PLUMBING FIXTURE FEE(<$500) 15.00
STATE SURCHARGE PLBG(<$500) 5.00
CULLIGAN SOFT WATER SERVICE CO. MAIL-]N FEE 2.00
6030 CULLIGAN WAY
MINNETONKA, MN 55345 TOTAL 22.00
(952)912-7379 Payment(s)
CREDIT CARD 8645 22.00
OWNER
DAYTON,JUDSON&ELIZABETH
121 S 8TH STREET#860
MINNEAPOLIS,MN 55402-
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 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.
/47-4 �. _' / / moi /
Apph 6 t Permitee Signature Date Issue, By Signature Date
12/11/2014 13:59 FAX 9529335049 CULLIGAN MNTKA U002
C • USE ONLY
OA` City of Orono Date Recei �1'/ Ponnir# /y,.
O 'vo P.O.Box 66
2750 Kelley Parkway
Z cCrystal Bay,MN 55323 Approved By: Amount S:
3 ei (952)249-4600
CTTY OF ORONO—PLUMBING PERMIT
(All Commercial permits must be approved by the Building Official or Inspector)
GENERAL INFORMATION•
J. 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 alter a review is completed. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT)3)EGIN UN CIL 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 dont 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) _
‘71.Residential ❑Commercial(Approval Required)
New ❑Additional I: 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: (�
Site Address: - S c -5 bl cx 5 a 13a •
Owner: - S 0 n _ 0'`13(b r Mailing Address:
City: Zip:
Home Phone: 101 a.'AL2 - I44,)-7 Alternate Phone:
[2ontractor Information:
C.:43,6rifgarWATER CONDITIONING Contact Person:
6030 CULLIGAN WAY
AchtIMIETONKA, MN 55345 State Bond#:
(952) 933-72(56
City: Zip: Expiration Date:
Phone: _ Alternate Phone: 15 -R a'311
❑ Insurance—Current:
1
12/11/2014 13:59 FAX 9529335049 CULLIGAN MNTKA 0003
, .
'1.7i?.ti:I.MliAlfi,,(,ii"fAV.gki',5,0.r .'41l:140. ; SISSN011irglAtILKO::ff?'''.g440;1`C',- ;;7,4r;
FIXTURE BSMT 1 2ND OTHER FIXTURE BSMT 2N° OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lavatory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
, •
Dishwasher Wet Bar
Sillcocks Miscellaneous
3104r
EE1-1PA. *lia•AM•VV03." • •,
0 Yes,this section applies
The replacement of a Residential fixture or appliance that meets all three of the following requirements:
1. Does not require modification to electrical or gas service.
2. Has a total cost of 5500.00 or less;excluding the cost of the fixture or appliance:and
3. Is improved,installed or replaced by the homeowner or licensed contractor.
Skip next section,if this applies; Cost of Permit $ 15.0Q
State Surcharge $
Mail-In Pee(If Applicable) S /00
Total Permit Fee
(Permit Fees Continued On Next Page)
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12/11/2014 14:00_FAX 9529335049 CULLIGAN MNTKA J 004
- T,1 ,-jai h T—'r' N'aNt
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 price) (minimum$50.00)
2. STATE SURCHARGE **Add thc State Bldg Code Div.Surcharge(Minimum Fee of$5.00)
x.0005 $
(contract price) (minimum S 5.00)
3. POSTAGE&HANDLING(Only on Mail-in Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ aa' 00
■ * 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 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$5.00—whichever is
greater. For valuations over$1,000,000 call they Building Departmentptat(952)2)24j9-4461000.for the} price. rya
`,','1�' !'FX7'9•.NZi,�NP�r ; �S"t'" Y.tEl `''b Ot t •�V,.+�' riga'LLt+'x+a'a'J.'.al' 'i�k°,�N�iI?IirC�sai,'�06`:w.rbi: �^4+'�C''1.
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: - J c-y"` Date: I a-- 0 - ( 7
or
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