HomeMy WebLinkAboutLA108330 PERMIT
City of Lakeville Permit Type: Plumbing
20196 Holyoke Ave Permit Number: LA108330
Lakeville, MN 55044
(952) 985-4440 * L R 1 QJ 8 3 3 QJ
www.ci.lakeville.mn.us Date Issued: 10/02/2008
Site Address: 16488 Falkirk Cir
Lot: 006 Block: 004 Addition: Fieldstone Creek 1st Addition
PID: 22-26700-060-04
Use: *22-267(ZJf7J-(~J6(d-Q14*
Description:
Sub Type: Lawn Sprinklers .
Work Type: Addition
Description:
Meter Size Meter Tvne Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: Description Amount Revenue Code
PL -Residential (Minimum) $39.50 1000-4152
Surcharge (.50) $0.50 1000-2127
Total: $40.00
Contractor: -Applicant - ~Wner:
Midwest Sprinkler Systems Inc DR Horton Inc MN
11865 West Douglas Road 20860 Kenbridge Ct Ste 100
Hastings MN 55033 Lakeville MN 55044
(651) 43.8-8605
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
i` ` ~ CITY OF LAKEVILLE Permit Number
~ BUILDING INSPECTIONS DEPARTMENT
l _~i 20195 HOLYOKEAVENUE
LAKEVILLE, MN 55044 Received
952-985-4440
w~~n~ .ci.lakeville.mn•us Date Received
DATE ~ ~ ` YOUR E-MAIL ADDRESS
r
SITE ADDRESS JJ
TENANT ~/i[°Gc ~l~f?s SUITE NO.
THE APPLICANT IS: ? RESIDENT OWNER CONTRACTOR
NAME c ~VL~S~G
RESIDENT OWNER ADDRESS r l~ y'.
CITY ilk C ~ STATE ?YI ~ ZIP 7 T
DAYTIME PHONE # WHERE YOU CAN BE REACHED ~,52-' ~7--7(~J~' 7
COMPANY NApME _ ' S~~E~
~ /lX~ rn
ADDRESS tI ~ , G~ ~
CONTRACTOR CITY ~~j STA~j liL! ZIP
OFFICE PHONE # (p,]~'J-~ ~ AX # j
/ -1~5~
CONTACT NAME. - ~ ~ ~ /,~~{'{~~Y~ PHONE ~
j ~ - ~3C~ ~ .CJs
COMMERCIAL ONLY RESIDENTIAL ONLY
? COMM PLMBG SYSTEM .AWN 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 ? REPLACE ? DEMOLITION
JOB DESCRIPTION . ~c~,~1c1y~
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
I-1/2% of contract cost up to $10,000 and $1.0,000.00 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 1 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 1 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 all work which requires review and approve] of plans ~J
NAME OF APPLICANT (Please Print) ~ Date ~~U
SIGNATURE OF APPLICANT:
PLEASE NOTE: SEPARATE PERNITTS ARE RE()tTTRED FOR Ali']' BUILBING,1\iLECI-IA;VICAL & ELECTRICAL \?VORI~ ~
PLUMBING PERMIT APPLICATION PAGE 2
OFFICE USE
SYSTEM TYPE: INSPECTIONS:
NEW /ROUGH-IN
ADDITION FINAL
REPAIR RPZ TEST REPORT
DEMOLISH COMBUSTION AIR
REPLACE UNDERGROUND
ALTER/REMODEL
PERMIT FEE:
PERMIT FEE: $
SURCHARGE: $
METER: $
REDUCING VALVE: $
MXU $
OTHER: $
$ {Y„
cI~
TOTAL:
ISSUED BY: ~p~( DATE: ID ~~-d
COMMENTS:
Revised 06/20/2007