City Of Oronoco
PLUMBING / WATER SERVICE
PERMIT APPLICATION
(Submit to City of Oronoco Upon Completion)
Fee: ______Date Paid: ______Permit No. ______
Date ______
Tenant/Building Name ______
Site Address ______
NumberStreetSuite/Unit No. Zip Code
City Subdivision and/or Addition Block Lot Plat Parcel
Applicant is: ___ Owner ___ Contractor ___ Other (describe) ______
PropertyName ______Phone (___) ______
OwnerLastFirst MIWork/Home
Address ______
City______State ______Zip Code ______
Sewer & Drain
Licensed
Contractor/Company ______Phone (___) ______
OtherWork/Mobile
Name ______Contr. No. ______
Address ______Master Lic. No. ______
City______State ______Zip Code ______
Engineer/Company ______Phone (___) ______
DesignerWork/Mobile
Licensed Plumber
Name ______Registration No. ______
LastFirst MI (State of MN)
Address ______
City______State ______Zip Code ______
WorkCategory___ Water Meter Only ___ Water Service & Meter
Permit Type___ Residential___ Commercial
Description of Work ______
______
Total Valuation of Work $______Permit Fee ______Surcharge ______Total ______
PLEASE CONTINUE ON OTHER SIDE
Fixtures___ Bathtub___ RPZ Backflow Preventer
___ Clothes Washer___ Sewer Ejector
Provide total ___ Dishwasher___ Shower Stall
number of___ Drinking Fountain___ Sink
each fixture___ Floor Drain___ Sump Pump
indicated.___ Laundry Tray___ Urinal
___ Lavatory___ Water Closet
___ Lawn Sprinkler___ Water Heater
___Pot & Scullery Sink___ Water Softener
___ Other ______Other ______
WaterInformation___ City Water ___ Well ___ City Sewer ___ Septic
Building Main Water Supply Size ______
_____Private Well _____ Shared Well
Who owns the well: ______
Has a well sealing / maintenance permit been submitted with Olmsted County? ______
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate.
The work will be in conformance with applicable laws of the State of Minnesota. I understand this is not a
permit but only an application for a permit and work is not to start without a permit. I acknowledge that the work
will be in accordance with all permit conditions and approved plans (in the case of work requires a review and
approval of plans). I understand that the City of Oronoco is not liable or responsible for any of the cost to construct a private water service pipe, complete plumbing improvements, installation of the water meter, site restoration or private well abandonment.
I hereby certify that I am properly registered and/or licensed as required by the State of Minnesota, or that I am
the legal owner of, and reside in, the above described residential property.
______
Applicant’s Signature Date
DO NOT WRITE BELOW THIS LINE – Office Use Only
FEE PARAMETERSREQUIRED INSPECTIONS
Calculated Valuation $______Underground
___ Permit Fee___ Waste & Vent
___ MN Surcharge___ Water
___ Investigative Fee___ Backflow Preventer
______Storm Water
___ Final
Comments: ______
______
Building Official: ______Date ______
City Clerk: ______Date: ______
Water Meter Serial #______
Water Meter Radio Transmitter Serial #______
Building Safety Department
~ Thomas Thompson ~ 507-356-8709 ~ ~
City of Oronoco
~ PO. Box 195 ~ Oronoco, MN 55960 ~ 507-367-4405 ~ Fax 507-367-4982 ~
Email: