HomeMy WebLinkAboutLA179228 PERMIT
City of Lakeville Permit Type: Fire
20195 Holyoke Ave Permit Number: LA179228
Lakeville,MN 55044
(952)985-4440 * L R 1 7 9 Z Z 8 *
www.cilakeville.mn.us Date Issued: 04/30/2020
Site Address: 16890 Klamath Tr
Lot: Block: Addition:
PID:
Use: Kingsley Place Senior Living * *
Description:
Sub Type: Fire Alarm System
Work Type: New
Description:
Construction Type:
Occupancy:
Zoning:
Sprinkled Area Updated Building
of Permit Totals
Stories: 0 0
Square Feet: 0 0
Percent of Bldg: 0 0
Comments:
Fee Summary' Descrintion Amount Revenue Code
� FI-Fire $250.00 1000-4152
Valuation: 20,000.00 Su�.charge-Based on Valuation $10.00 1000-2127
Total: $260.00
Contractor: - Applicant - Owner:
Chamberland Fire
15510 Cornell Tr
Rosemount MN 55068
(651)322-5024
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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� /-�-'.�. Office Use Only
FIRE PERMIT APPLICATION '�� _I�"L�_'2-�C:�
Pernut umbe
CITY OF LAKEVILLE �I�
BUILDING INSPECTIONS DEPARTMENT Wd
/ • � 20195 HOLYOKE AVENUE Received BIE�—
LAKEVILLE,MN 55044 ��a��
952-985-4440 Date Received
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TENANT �r�f�Si�.�Y ����r}�:.� c��::,�;,,y,�. j„��i..%� SUITE NO.
COMPANYNAME �H�'"'ti+;f�-�++o,� �"+�.�' �&c-�='i'�'fi�'�LICENSE# T^5�tn4�
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CONTRACTOR
CITY Y�!�S�rL"�v rff'� STATE � '� ' ZIP ����.�'.'1
CONTACT NAME 1�� ��"'���'^'� OFFICE PHONE# c.s>e. �'L"Z-SI`'�=�'
DAYTIME PHONE#WHERE YOU CAN BE REACHED C��t � ������"�'
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'k..NEW_.
ADDITION ALTER/REMODEL
TYPE OF WORK
REPAIR REPLACE DEMOLITION
Automatic Fire-Extinguishing Sys Industrial Ovens
PERMIT SUB-TYPE Standpipe Systems LP Gas
Flammable&Combustible Liquids Systems Paint Booth
Hazardous Material
TY FIRE ITEMS TY FIRE ITEMS
Dry System New Sprinkler Heads
Wet System Relocated Sprinkler Heads
Preaction System Spare Sprinkler Heads&Wrench
FIRE ITEMS
Delage System Underground Fuel Tank
Compressed Gases Above Ground Fuel Tank
Fire Pumps&Related Equipment � Fire Alarm Low Voltage
JOB DESCRIPTION: .S IV=>T�}+—:`' �c°i L.���t--- �i �i�'. /'��r2v�{ �`�577L'n'1
FIRE PERMIT FEES:
Residential Fees: New Construction$90.00+$1.00(State Surcharge)_$91.00
Remodel$45.00+$1.00(State Surchazge)_$46.00
Commercial Fees:
Job Cost: $_ ��--'�� ��'M•�-Y`
Example:$12,000 Job Cost
1-1/2%of contract cost up to$10,000 and �'�J�^ ��' $10,000.00 x 1.5%_$150.00
1%of cost above$10,000 plus surchazge. + � p O C�r $ 2,000.00 x 1% = 20.00
(Surcharge=Contract Cost x.0005) + �� ,tT" $12,000 x.0005 = 6.00
Total - �!c�(3 �� TOTAL $176.00
Minimum of$45.00+$1.00(State Surcharge)_
Applicant's Printed Name ��1�.i� �—� G��113�".?-L3'���
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Applicant s Signature •'"+� '`" �. - �„ -�"r�'" Date rr
FIRE SUPPRESSION PERMIT APPLICATION PAGE 2
OFFICE USE
SYSTEM TYPE: INSPECTIONS:
�NEW AIR TEST
ADDITION �_FINAL
REPAIR FIRE PUMP TEST
DEMOLISH FLOW TEST
REPLACE FLUSHING
ALTER/REMODEL HYDRO-STATIC TEST
MAIN DRAIN TEST
OTHER
�_ ROUGH-IN
TANK/PIPING REMOVAL
TRIP TEST
PERMIT FEE:
PERMIT FEE: $
SURCHARGE: $
OTHER: $
TOTAL: $
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ISSL�ED B ' DATE:
COMMENTS:
Revised 12/28/2017