HomeMy WebLinkAboutPlumbing Permit PERMIT
City Of Lakeville Permit Type: Plumbing
20195 Holyoke Ave Permit Number: LA105948
Litkeville, MN 55044
(952) 985-4440 * L A 1 0 5 9 4 8
www.ci.lakeville.mn.us Date Issued: 05/20/2008
Site Address: 16443 Dodd La
Lot: 001 Block: 004 Addition: Fieldstone Creek 1st Addition
PID: 22-26700-010-04
Use: ~k2z-267(17f7J-(~ 1(?J-Q14%K
Description:
Sub Type: Water Softener
Work Type: Addition
Description:
Meter Size Meter Twe Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary' Description Amount Revenue Code
PL -Water Softener/Filtration $19.50 1000-4152
Surcharge (.50) $0.50 1000-2127
Total: $20.00
Contractor: -Applicant - OWner:
Merles Water Corp DR Horton Inc MN
2200 East Highway 36 20860 Kenbridge Ct Ste 100
North St Paul MN 55109 Lakeville MN 55044
(651) 777-1349
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.
Applicant/Permitee: Signature Issued By: Signature
PLUMBING PERMIT APPLICATION office vse on?y
f; . ~ ~ CITY OF LAKEVILLE Permit Number
~ r BUILDING INSPECTIONS DEPARTMENT
l ~ ~ 20195 HOLYOKE AVENUE
Received B
~ ~ LAKEVILLE, MN 55044 ; ?w; , _ ~1 ~ %'1 ~ ~ ~1
952-985-4440
«1anv.ci.lakeville.rnn.us Date Received
DATE ~ ~
YO'U~R E-MAILL ADDRESS
SITE ADDRESS- !cp ~~3 //~~y'1 L.IS{/1~~
TENANT~~ ~ "~c~~ Goy) SUITE N0.
THE APPLICANT IS: ? RESIDENT OWNER C~CONTRACTOR
NAME ~ ~fi~>v
RESIDENT OWNER ADDRESS !L{ ~ u°~c C-ct f~
CITY ~ c° ff (~l STATE ?/y1~ ZIP .S
S'^O
DAYTIME PHONE # WHERE YOU C)AN BE REACHED
COMPANY NAME ~ ~~~Nl l LICENSE # t~~` ~c
ADDRESS (.e1 ~ . f
CONTRACTOR CITY ~ " _ ~ STATE ZIP
OFFICE PHONE # T7~"p~3 ~I °I FAX #
CONTACT NAME ~j{-V e f'\L°~ N ~ y'` PHONE I " 7 ~ ~ 3~
COMMERCIAL ONLY RESIDENTIAL ONLY
? COMM PLMBG SYSTEM ?-LAWN SPRINKLER ? INSIDE PLBG
PERMIT TYPE ? COMM/MULTI-FAMILY 'WATER SOFTENER CONVERSION
LAWN SPRINKLER ? WATER HEATER ? ADDN/REPAIR
? FIRE SPRINKLER ? MISC
? RPZ (Available on-line Residential Permits Available on-line
'NEW ? ADDITION ? ALTER /REMODEL
TYPE OF WORK
? REPAIR ? REPLLACE ? DEMOLITION
JOB DESCRIPTION ~~(e- L ~IS"~°t- ~ t
RESIDENTIAL FEES:
Repairs/Remode] or Water Heater $40.00 (39.50 + .50 surcharge) Water Softener $20.00 (19.50 + .50 surcharge)
COMMERCIAL FEES:
JOB COST: $
Example: $12,000 Job Cost
1-1 /2% of contract cost up to $10,000 and $ I Q,000.00 x I.5% _ $150.00
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 = TOTAL $176.00
Minimum of $40.00 (39.50 + .50 surcharge)
NO. OF METERS SIZE OF METER LOCATION OF METER
1 hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Lakeville and with the Minnesota Plumbing Codes; that I understand this is not a
permit but only an application for a permit and work.is not to start without a permit; that the work wiil be in accordance with the approved plan
in the case of all work which requires review and approval of plans.
NAME OF APPLICANT (Please Print) ~ n~ e ~ ~ Date `tea
SIGNATURE OF APPLICANT:
PL)JAS'E NOTE: SEPARFi"iT PERMI; S.ARE1~ D FOR AN9' tiILDING, R°IECHANICAL & ELECTRICAL WORD
PLUMBING PERMIT APPLICATION PAGE 2
OFFICE USE
SYSTEM TYPE: INSPECTIONS:
NEW ROUGH-IN
'1 ADDITION _ ? FINAL
REPAIR RPZ TEST REPORT
DEMOLISH COMBUSTION AIR
REPLACE UNDERGROUND
ALTER/REMODEL
PERMIT FEE:
PERMIT FEE: $
SURCHARGE: $
METER: $
REDUCING VALVE: $
MXU $
OTHER: $
TOTAL: $ "
ISSUED BY: j
~E6 DATE: ~ U ~ C~
COMMENTS:
Revised 06/20/2007