HomeMy WebLinkAboutLA177961 PERMIT
City of Lakeville Permit Type: Plumbing
20195 Holyoke Ave Permit Number: LA177961
Lakeville,MN 55044
(952)985-4440 �k L R 1 7 7 9 6 1 �K
www.ci.lakeville.mn.us Date Issued: 03/17/2020
Site Address: 17440 Glacier Way
Lot: Block: Addition:
PID:
Use: Springs of Lakeville * *
Description:
Sub Type: Commercial Plumbing System
Work Type: New
Description: Building 7
Meter Size Meter Tvne Manufacturer Serial Number Remote Number Line Size
Comments; NEW MULTI-FAMILY.
Fee Summary' Descri tion Amount Revenue Code
Valuation: 150,000.00 Commercial Plumbing $1,550.00 1000-4152
Surcharge-Based on Valuation $75.00 1000-2127
Total: $1,625.00
Contractor: - Appli�ant - Owner:
RHD Plumbing Inc
1480 Oak Opening Dr
Soughton WI 53589
(608)873-8903
I HEREBY AGREE THAT THIS WORK WILL BE PERFORMED ACCORDING TO:(1}THE APPROVED PLANS&
SPECIFICATIONS;(2)THE APPLICABLE CITY ORDINANCES&CODES;AND(3)THE MN STATE BUILDING CODE.
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Applicant/Permitee: Signature �� Issued By: Signature
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��flice Use Only
PLUMBING PERMIT APPLICATIOn `1 (�
Permi(Nwi�
=�:��.` CITY OF LAK�VILLE
BUILDING INSP�CTIONS DEPARTMENT
+ 20395 HOLYOKE AVENUE Receivec�By
LAKEVILL�,MN 55044
952-985-4440
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Date R�ed�I�� ��
y-v�, ,
�? 7�, Pertnit Fee
t��'3,`l'G d����J� ���ti1 YOUR E-MA1L ADDRESS�J��.h�'1�'����1��-=—yifl�t,C.C)t''t
s�TE,�uU��;ss 17�1�10 ���,'�C �Ja�
TGNANT �dR���1CJ��'A� �7� FV� . LL�, SUITENC),
THE APPLICANI'1S: ❑REStDEN'r flWNFR �CONTRACTOR
_ �.
NAME
RESIDENT OWNER ADDRESS
CiTY STATE 71f'
DAYT(MF,4'HONE#W HF.RE YOU CAN BE}2EACHED
COMPANY NAME t t� Y,VP�'1�irl {�(� LICENS£ #�G���6
CONTRAC'COR An�iR�SS ��"��U C�o6k � it1 �'i V�i
Company name must be as CITY �T fl�,�Tet`1 STATE �Z ZIP �3 5 g�
appears on State Lice»se pg�ICE PHOh1E# ��aQ�� 73 "� i�3 FAX#
CONTACTNAME �Oh�1 SQi�t'han PHON� 4'��� ���,��77��
COMMER+CYAL OlVLY RESID�NTIAL QNLY
�'COMM PLMBG SYSTEM ❑LAWI�1 SPRfNKLER ❑INSIDE PLBG
C�COMM/MUI.T1-FAMII.Y ❑WATER SOFTENER CONVLRSTON
PEI2MIT TYPE LA�VN SPRINKLrR ❑WATER HEATLIt ❑ADDNlRI'PAIR
QFIRE SPRINKLER ❑MISC(fill description)
Q BACKFL(7W
INSTALLA7ION Residential Permits Avnilable on-line
❑NEW ❑ADDITI�N ❑AT.TER/REMODEL
TYP�OF�VORK
�]REPA1�t ❑REPLACF: Q DLMOL.I'i'ION
J�B I�ESCRIP'I'TON �t��'i� "` i� � ��i(�; �* �+�� �
RESIDENTIAC.FF,ES:
Repairs/Remodel,Water Heater or Water Sofiener $40A0+State Surcharge{$1.0p)
COMMERCIAL FEES:
JOB COST: $ ��j�}, ��,b0 G� 0 Example: $12,Q�0 J�b Cost
1-1/2°/a of contract cost up io$10,000 �,>��� $l0,Ofl0.00 x 1.5%= $150,00
1%ofcost above$1�,Q00 plus surcharge +��Q(',C�C� $ 2,000,00 x l% = + 20.00
{Surcharge=Contract Cost x.00OSj + '7�"�� $1 Z,000 x.0��5 — + 6.00
TOTAL = $��,��S 4� — $176.00
Minimum of$40.00+Sta#e Surcharge($1.OQ)
NO.OF METERS SIZE OF METER LOCATI�N OF METER
�" S�V � c v�1 '
I hereby apply for o plumbiu� pennii und I neknowledge that the information above is compiete and accurate; ihat the work will be iu
conformance with the ordinances and codes of the City of Lakerille and with the Minnesota Plumbing Codes;that T understand this is not a
pennit but only aii application for a permit and work is not to start without a pennit;that the work will be in aecordance with the approved plan
in the case of all work ivhich requires review and approval of plans.
NAME UF APPLiCANT{Piease Print) �q,i�,��p,�"1� Date b� 3 a„
SIGNATUR�OF APPLICANT:
�'I:�d1��.,2�1�'`�.h��l�it��lt1'�£'�"����A�tlt;�_ ��1�#�'R�AI�Y:�TdIl.D�3�T :w `�Afi�. r ` +&EI.�CI'R�TCA��'4�+UR[�::� - ;:.�
,� �!_�{\-`'1 l, ' ' � ��;� l �' rv,�.i'� �.�} __ � '� — Y`�I;
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PLUMBING PERMIT APPLICATION PAGE 2
OFFICE USE
SYSTEM TYPE: REQUIRED INSPECTION:
�NEW COMBUSTION AIR
ADDITION �FINAL
REPLACE OTHER
ALTER/REMODEL � ROUGH IN
REPAIR BACKFLOW TEST REPORT
DEMOLITION ��JNDERGROUND
PERMIT FEE
PERMIT FEE: $ �SJ�� . O�
SURCHARGE: $ �,� . � l�
METER: $
REDUCING VALVE: $
MXU: $
OTHER: $
TOTAL: $ / �o �"S D (�
ISSUED BY: � DATE: �- �l' �O
. .�
COMMENTS: �� "�(v�„f..��� �
(Revised 12/28/2017)