HomeMy WebLinkAbout2016-00896 - plumbing t � CITY OF ORONO
2750 KELLEY PARKWAY * 2 0 1 6 - 0 0 8 9 6 *
DATE ISSUED: 07/28/2016
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 500 OXFORD RD
PIN : OS-117-23-41-0015
LEGAL DESC : STIELOWS ADDN
: LOT 007 BLOCK 001
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIXTURE
NOTE: WATER HEATER
VALUATION OF PLUMBING 900
APPLICANT PLUMBING FIXTURE FEE 50.00
STATE SURCHARGE PLBG(VALUATION) 0.45
AIRICS HEATING LLC MAIL-IN FEE 2.00
2609 HWY 13 W
BURNSVILLE,MN 55337- TOTAL 52.45
(952)345-0032 Payment(s)
Minnesota State License#:mech-MB004088 CHECK 16299 52.45
OWNER
NELSON,ALBIN&SUSAN
500 OXFORD 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 dces
not gant 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
exp've and become null and void if construction authorized is not
commenced within I80 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.
C,►���� ? /��/ ��
Applicant Permitee Signature Date Iss ed y Signature Date
r � �p� City of Orono „ FOR CITY E NLY
O P.O.Box 66 �t�tl�t� Date ReCeived: 7` / �
2750 Kelley Parkway permit# �<<P'��� �� � <
y� �. Crystal Bay, MN 55323 ��� 2 g 2016
c? (952)249-4600—Main � qppnpVed By:
�'�kEsnoa�' (952)249-4616—Fax �
C1TY OF ORONO q�unt$: �`�•
CITY OF ORONO— PLUMBING PERMIT
(All Commercial Permits Must be Approved by the State Prior to City Approval)
httq://www.dli.mn.ctov/CCLD/PDF/pe plumbplanrevapp.pdf
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 retum 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. Alt 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 OFPERMIT(Check At� That Apply)
,�Residential ❑ Commercial (Approval Required) [Backflow Device: ❑AVB ❑PVB]
❑ New ❑Additional ❑ Repairs �place
❑ In Accessory Structure?
`You will need arior aaqroval and may need CUP. (Per Orono City Code, Chapter 78, Article IV)
Job Site/Owner Information:
Site Address:r'J0� �'�Y U� ��
Owner:SU1��l In N���� Mailing Address: 5� �,�
Ciry: ���(J Zip: ���7
Home Phone: �"f,J21�1�'� ��� Altemate Phone:
Contractor Information:
Contractor: ��(V Q�" Contact Person: ��� '
Address: I�I�LS ��IJ��Yk �VI VQState Bond #:�G�o���
City: �(� �� Zip:��12 Expiration Date:�Z I I
Phone: ��r'rJ7i�7G1� - ��fI� Altemate Phone:
Insurance-- Current:
Page 1
. ,
FIXTURE BSMT 1sT 2ND pTHER FIXTURE BSMT 1sr 2ND OTHER
TYPE Fioor Floor TYPE Floor Floor
Water Closet Floor Drains
Lavatory Sewe�Ejector
Bathtub Laundry Tray
Shower Washer
Kitchen Sink Water Meater 1
Disposal Water Softener
Dishwasher Wet Bar
Sillcocks Miscellaneous
1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.00)
1 � •� x .0125 $ V.X.�1sZ� �•(�
(contract price) (minimum $50.00)
2. STATE SURCHARGE
` � `� '" v x .0005 $ � `T�
(contract price)
3. POSTAGE 8 HANDLING (Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE (Add Lines 1-3 Above) � �Z • �' �
'' CONTRACT PRICE or JOB COST means the actual or estimated dolla� amount charged for the
permitted work inctuding 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 undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in
strict accordance with the or 'nances of the City and the regulations of the State of Minnesota, and
certifies that all statement a e n this application are complete, true and correct.
Applicant's Signature: Date: ���� �l "`L
Building O�cial/ Inspector: Date:
Page 2