HomeMy WebLinkAboutLA184725 PERMIT
City of Lakeville Permit Type: Plumbing
20195 Holyoke Ave ,µ ���., Permit Number: LA184725
Lakeville, MN 55044 �
(952)985-4440
* LFl 1847z5 *
www.ci.lakeville.mn.us Date Issued• 10/12/2020
Site Address: 16890 Klamath Tr
Lot: Block: Addition:
PID:
Use: Kingsway Sr Living
* *
Description:
Sub Type: Comm/Multi-Family Lawn Sprinkler
Work Type: New
Description: Deduct meter not allowed.
Meter Size Meter Tvne Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: Description Amount Revenue Code
PL-Commercial(Minimum) $40.00 1000-4152
Surcharge- $1.00 $1.00 ]000.2127
Water Meter $970.00 7600-5161
Total: $1,011.00
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Contractor: - App�;ca„t - Owner:
J-Berd Mechanical Contractors Inc
PO Box 7308
St Cloud MN 56302
(320)656-0847
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
PLUMBING PERMIT APPLICATION Office Use Only
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Pennit Number
_ CITY OF LAKEVILLE
BUILDING INSPECTIONS DEPARTMENT �`, A. t, �� `� �;�,-% '���, �
� 20195 HOLYOKE AVENUE Received By
LAKEVILLE,MN 55044 - �`
952-985-4440 '�� � �� �_..
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www.lakevillemn.eov Date Received
�.00� �� L� � , CC
� /� '} . Permit Fee
DATE ��p'LVLV YOUR E-MAIL ADDRESS ,n�
SITE ADDRESS��a�Z �,l,Qj��_�{�1 �
TENANT ��1�(�`t,Tl�� �(D(� ��„uj VLGI SUITE NO.
THE APPLICANT IS: ❑RESIDENT OV��NER (�CONTRACTOR
NAME �'
RESIDEIVT OWNER ADDRESS
CITY . STATE�jv ZIP��/Q
DAYTIME PHONE#WHERE YOU CAN BE REACHED qrj�.•9Z�•' IS7L
COMPANY NAMff,,��,���/['� LICENSE #�
CONTRACTOR ADDRESS "/�(,[j'f"j�j�Lt,( ��i/�/'�
Company name must be as CIT1'� � f)/�j' STATE���ZIP� !�7 aJ
appears on State License OFFICE PHONE#
FAX#
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CONTACT NAME � PHONE
COMMERCIAL ON�.Y RESIDENTIAL ONLY
❑COMM PLMBG SYSTEM ❑LAWN SPRINKLER ❑INSIDE PLBG
�COMM/MULTI-FAMILY ❑WATER SOFTENER CONVERSION
PERMIT TYPE LAWN SPRINKLER ❑WATER HEATER ❑ADDN/REPAIR
❑FIRE SPRINKLER ❑MISC(fill description)
❑BACKFLOW
1NSTALLATION Residei�tia!Permits Availnble on-line
TYPE OF WORK EW ❑ADDITION ❑ALTER/REMODEL
❑REPAIR ❑REPLACE ❑DEMOLITION
JOB DESCRIPTION j� �.��� � 7� �` �D��
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RESIDENTIAL FEES:
Repairs/Remodel,Water Heater or Water Softener$40.00+State Surcharge($1.00)
COMMERCIAL FEES:
JOB COST: $ Example:$12,000 Job Cost
1-1l2%of contract cost up to$10,000 $10,000.00 x 1.5%_ $I 50.00
1%of cost above$10,000 plus surcharge + $ 2,000.00 x 1% _ + 20.00
(Surcharge=Contract Cost x.0005) + $12,000 x.0005 = + 6.00
TOTAL = $0.00 = $176.00
Minimum of 540.00+State Surcharge($1.00)
NO.OF METERS SIZE OF METER LOCATION OF METER
f hereby apply fnr a plumbing perniit and 1 acknowledge ihat the information above is complete and accurate; that the work will be in
cunformance with the ordinances and codes of lhe City of Lakevillc and with the Minnesota Plumbing Codes;that I understand this is not a
pemiit but only an application for a pennit and work is noi to start without a permit;that the work will be in accordance with the approved plan
in the case of atl work which requires review and approval of plans.
NAME OF APPLICANT(Please Print) Date
SIGNATURE OF APPLICANT:
P�,EASE NOTEi SEP�IRATE PERMITS ARE RE UIRED FO 'Y BU1LDiNG MECHANICAL&E1�'ECTItICAi.:WORK