HomeMy WebLinkAboutPlumbing Permit PERMIT
City of Lakeville Permit Type: Plumbing
20195*Holyoke Ave Permit Number: LA105949
Lakeville, MN 55044
(952) 985-4440
%KLA 105949*
www.ci.lakeville.mn.us Date Issued: 05/20/2008
Site Address: 16491 Dodd La
Lot: 005 Block: 004 Addition: Fieldstone Creek 1st Addition
PID: 22-26700-050-04
Use:
* z Z- Z 6 7 X10 - P15 - f~ 4
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
I
PLUMBING PERMIT APPLICATION Office Use Oniy
~ ~-...C>
CITY OF LAKEVILLE ermitNumber i
Ir \ BUILDING INSPECTIONS DEPARTMENT
/ ~ ~ ~ 20195 HOLYOKE AVENUE
` ~ LAKEVILLE, MN 55044 Received By
952-985-4440
~jnvt~~.ci.lakeville.mn.us Date Received
DATE `~U ~ YO!UR E-MAIL ADDRES S
SITE ADDRESS~~ip1L/~ j ~GC~I ~
TENANT o` ~ SUITE NO.
THE APPLICANT IS: ? RESIDENT OWNER CONTRACTOR
NAME ~ ` C
RESIDENT OWNER ADDRBSS_~~~/ j ~ 1r
CITY ~Q / 1 C`e STATE ~'1 ~ ZIP _jJ ~ 7
DAYTIME PHONE # W~H~E,pRE YOU CAN B1ER~EACHED Q
COMPANY NAME y < `e-~ ~S ~4 1 ~^e CdNF't I ~CG~~i ENSE
ADDRESS 36~
CONTRACTOR CITY ~"r = L STATE ljL( hs ZIP ,.S~~I~
OFFICE PHONE # C 7'- r~Y°~ FAX #
CONTACT NAME PHONE b'`SI
7 ~ 7--C 3l( l
COMMERCIAL ONLY RESIDENTIAL ONLY 6
COMM PLMBG SYSTEM ? LAWN SPRINKLER ? INSIDE PLBG
PERMIT TYPE ? COMM/MULTI-FAMILY ATER SOFTENER CONVERSION
LAWN SPRINKLER ? WATER HEATER ? ADDN/REPAIR
? FIRE SPRINKLER ? MISC
? RPZ (Available on-line) Residential Permits Available on-line
EW ? ADDITION ? ALTER /REMODEL
TYPE OF WORK
? REPAIR .,L 0 REPLACE) / ? DEMOLITION
JOB DESCRIPTION_~~~1 ~~R 1 l
RESIDENTIAL FEES:
Repairs/Remodel or Water Heater $40.00 (39.50 + .50 surcharge) Water Softener $20.00 (19.50 + .50 surcharge)
COMMERCIAL FEES:
JOB COST: $
Example: $12,000 Sob Cost
1-1/2% of contract cost up to $10,000 and $10,000.00 x 1.5% _ $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
I hereby apply for a plumbing permit and ]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 will be in accordance with the approved plan
in the case of alt work which requires review d approval of p s. ~
r' I ~ ~i vE7 n ' ,,r~ l~ G ~
CJ
NAME OF APPLICANT (Please Pnnt) ~ / ~ ~ ~'C Date
r ~
SIGNATURE OF APPLICANT:
:PLEASE NOTE: SEPAItgTE PER11fITS AR REQUIRED R:4.'~ BUI• "G. IVIECEL4NICAL 8: ELECTRICAL WORii
I
PLUMBING PERMTT APPLICATION PAGE 2
OFFICE USE
SYSTEM TYPE: INSPECTIONS:
f /NEW ROUGH-IN
V ADDITION FINAL
REPAIR RPZ TEST REPORT
DEMOLISH COMBUSTION AIR
REPLACE UNDERGROUND
ALTER/REMODEL
PERMIT FEE:
PERMIT FEE: $
SURCHARGE: $
METER: $
REDUCING VALVE: $
MXU $
OTHER: $
TOTAL: $ ~ U ~
ISSUED BY: DATE: -~c~' U K
a
COMMENTS:
Revised Ob/20/2007