HomeMy WebLinkAbout2016-00394 - plumbing CITY OF ORONO
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* 20 1 6 - 00394 *
2750 KELLEY PARKWAY DATE ISSUED: 04/19/2016
i" ORONO,MN 55356-
(952)249-4600 FAX: (952) 249-4616
ADDRESS : 585 ORCHARD PARK RD
PIN : 31-118-23-14-0001
LEGAL DESC : UNPLATTED 31 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER SOFTENER
NOTE: REPLACE WATER METER
VALUATION OF PLUMBING 500
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.25
CULLIGAN SOFT WATER SERVICE CO. MAIL-IN FEE 2.00
6030 CULLIGAN WAY
MINNETONKA,MN 55345- TOTAL 52.25
(952)912-7379 Payment(s)
CREDIT CARD 5107 52.25
OWNER
THOMAS,DONALL&HENRIETA
585 ORCHARD PARK RD
LONG LAKE,MN 55356-
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 be0
f�
revoked at any time for due cause.
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Applicant Permitee Signature Date Issued By Signature Date
04/19/2016 10:33 FAX 9529335049 CULLIGAN MNTKA ll 014
PO CITY USE ONLY
O City of Orono AII,n, �!1
P.O.Box 66 Date Received: 1'7 /' Permit# v 1(6-CO 5r�Y
� 42750 Kelley Parkway
. , Crystal Bay.MN 55323 Approved By: Amount S:�
• (952)249-4600
CITY OF ORONO--PLUMBING PERMIT
(All Commercial permits must be approved by rhe Building Official or Inspector)
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 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 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 PERT
(Check All That Apply) _
Residential 0 Commercial(Approval Required)
0 New ❑Additional 0 Repairs
*eplace
❑ In Accessory Structure?
*You will need prior approval and may need CUP.(Per Orono City Codc,Chapter 78,Article IV)
Job Site/Owner Information;
Site Address: 5731__Ord
In r,���l 1-rJIYod
`} �
Owner: Nil n�l\i y{Vin\ I I i Mailing Address: 1
City: _ Zip: 56-35 cv
Home Phone: ----AP 3 - o'-'tis)) Alternate Phone:
Contractor Information:
- I
Contractor:
Contact Person: Al& k
Address: 6030 CULLIGAN WAY
MIN 45 State Bond#:
City: (952) 933-720i
_ 0ip: Expiration Date:
Phone: - 1 Phone: 6153--at) — 2j •
❑ Insurance—Current:
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04/19/2016 10:33 FAX 9529335049 CULLIGAN MNTRA lj 015
040000,43,1teginZtaNSTAIUO ,").
FIXTURE ' BSMT 15r 2N OTHER FIXTURE BSMT l 2ND OTHER
TYPE FL FL TYPE FL FL
Water Closet Floor Drains
Lai/atory Sewer Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Heater
Disposal Water Softener
Dishwasher Wet Bar
Sillcocics Miscellaneous
vilr.1",:gt:INdpi:;IqC41:4,94itag,g00442ittglig.
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$500.00 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 $ 15.00
State Surcharge S 5.00
Mail-In Fee(If Applicable) $ .2.g0
Total Permit Fee
(Permit Fees Continued On Next Page)
2
04/19/2016 10:33 FAX 9529335049 CULLIGAN MNTKA 0016
ol� N✓` . r tt �T, 'VT $w), :01 �i Lys +?.e�Cr�!ii rrp„dr1 e'.'1Ca
'��;�1r`�.a�i�, r"� �...�.a.' . d' .mJ:—^�'��� ��';d:7�nr'�P�.O,�UU!,;r�..
If above does not apply;follow guidelines below:
1. CONTRACT PRICE w is 1.25%of contract price o iith a(Minimum Fee of 550.00) 0�
6 U x.0 1 25 5
., )' -(contract pri (minimum$50.00)
2. STATE SURCHARGE **Add the State Bldg Code Div.Surcharge(Minimum Fee of
x.0005 $ O
(contract price) (minimum$ 5.00)2,11Q � .D /
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2, . 7�/
4. TOTAL PERMJT 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 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 SUkCHARGE is.0005 of the contract price under 51,000,000 or 55.00—whichever is
greater. For valuations over$1,000,000 call the Building Department at(952)249-4600 for the price.
, `A.kl` r7MNi $004061M'-:: .4):1,''.,i' n�r7fa'i: _4 a FM
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.
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Applicant's Signature; ~ Date: q , 1 ck)(N
iii�r .oto de;w±hi'
;l,,i.r%41.N' q611
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