HomeMy WebLinkAbout1986-8775 - general permit GENERAL PERMIT ��P�� N� s 7 7 5
CIT� OF ORONO
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CRYSTAL BAY,MINNFSOTA 55323
(612)473-7357
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City License No. City
REMARKS AND SPECIAL CONDTTIONS
PERMTT TYPE AND FEE: O NEW �ADDITION ❑ REPAIR ❑ REMODEL
Inside Plumbing(#fixtures � ) Fee $� � Water Well Fee $
Water Meter(Size ) Fee $ Mechanical Equipment Fee. $
Meter# Fireplace/Wood Stove Fee $
Remote# Moving/Lifting Btu7dings Fee $
Municipal Water Connection Fee $ Land Alteration(F.xc;avation,
❑ Copper ❑ Grading,F�ling,ezc.) Fee S
Design Review Fee $
Municipal Sewer Connection Fee $ Fire Fee $
❑ PVC ❑ Cast O
Sprinkler System(Fire) , Fee $
MWCC SAC Charge Fee $ p�er. �,- -��� Fee $ �
On Site Spetic System Fee $
After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
State Surcharge: Fee $ ' Sv
The u�ersigned hereby ackrrowledges recei}n of this limited permit, �d
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including aoceptance of all special ��o�uo�, ��, ��a;eo� a Total Amount Paid to City Fee $�" �
requirements written above. The undersigned u�ersrands and agrees
under penalty of law that this permit is strictly Gmited in scope to the work, /I L/���}(l�
activity or improvement spectified;that this pertnit dces not grant any �•'T�� 7 a
suthority todo work or activities requiring separate permitapprovals;and
that this pertnit dces notgra►rt authority to violate any provision of any C�ty
ordi�nce or Smte law,rule or regulation.All work shall be done in strict 'I'�permit is not valid unt�the proper fee is paid and it is approved
compliance with alt City ordi�mnces, building codes and/or health by an authorized City O�cial.
de�rtment regulauons,and shall be subject to insperdon,approval or
rejection by the CSry.Whenever so ordered,the undersigned agrees to
rnrnect any work found to be in violation of the co�idons of this permit.
Signature of Applicant
• Signature f City O�cigl "
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Code: White—File Copy Canary—Inspedor's Copy Pink—Finance Copy � Gdd-ApplicanPs Reaeipt
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a
Box 66 (1335 Brown Road South)
Crystal Bay, MN 55323
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General Information
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1. You may apply for plumbing permits by mail or in person at the City offices. �
2. Mailed in application are sub ject to the postage and handling fees shown below. Permit Cards wi
be sent by return mail the same day the application is received. �
3. Pezmits are not valid until you receive a permit card.
q, work muot not begin until the permit card ia posted on the job sito.
5. Plumbing permits may beissued to state-licensed plumbezs or to homeowner/occupanta who intend � �
pctually perform their own work in their home. t
6. When any new construction or remodeling is involved, a separate buildinq permit must be obtain
7. All work must be done in accordance with the State Suilding Code Requirements. �
8. All work must be inspected before it is covered. Call for inspections 24 hours in advan
(473-7357).
Instructions. Complete all items on this application. Compute the permit fee. Siqn and date
certification. Incomplete applications will not be processed. if you have, any questions,
473-7357. ''
WALR-IN PERMITS--Apply at City Offices, 1335 Srown Road So. (County Rd 146)
MAIL-IN PERMSTS--Enclose Fee--Mail to: P.O. Box 66, Crystal Bay, MN 55323
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JOB SITE ADDRESS ��fJ,� ,f'/}Q/L ,�P.3�,�1:�-
Occupancy Type: +.� Residential Commercial
Work to be Performed by: Licensed Contractor � Owner/Occupant
OWNER'S NAME (��j�-,1��'�'1 ,� r ,S�_�-f�3L L. Telephone No. �7� -��J�
Mailing Address _ („[?c �• ,�-p K ��;� /.cr.►�,;� tt�k.�. f�9�1 c S 3.��
PLUMBER'S COMPANY N1�ME S �,� �l3 c�� Bu s i ne s s No.
Mailing Address
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Master Plumber ' s State License No. City Cert. No. s
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PLIIMBING FIXTIJRB SCHSDQLB
(Show Number of Fixtures of Each Type on Each Floor)
FIXTURE TYPE HSMT. lst Floor 2nd Floor Other Floocs FIXTLIRE TYPE BSDiT, lsi Flooc 2nd Floor Other Floors
water Closet Laundr�Trav
Lavatorv Washer
Bath[ub � Water �leater
Shover _ Water Sofcner �
KitcFen Sink _ Misc. Fixtures: �
Dis�osal (Lis U
D i s'��.•a s.`.e r
Wet Bar
Sillcocks
Floor Drains
Sum Pum _.
Sewer E'ector '"�T.A �UMBER OF FIXTURES
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PERMIT FEE CALCULATION
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1 . Fixture Fee. The minimum permit fee is $25. 00.
Compute number of fixtures x $4/fixture $ �S y"
2. State Surcharge $ .50
3. Postage and Handling (Only for Mail-in applications ) $ 1. 50
4. TOTAL Permit Fee (Add lines 1-3 above ) $ � �, O �
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The undersigned hereby applies to the City of Ozono for issuance of n PLUMBING PERMIT, agrees to do all I
work in s ict accordance with the ordinances of the City and the regulations of the Minnesote State ;
euild' ode, nd certi 'e tha a atatements made on thia application are complete, true end
corr `� � �.�C/ /Y�
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Signa uze of Appl cant Date