HomeMy WebLinkAboutLA109324 PERMIT
City Of LakCVllle Permit Type: Plumbing
20195 Holyoke Ave Permit Number: LA109324
Lakeville, MN 55044 1ll1~11
(952) 985-4440 w*uwL R 1 0 9 3 2 4
www.ci.lakeville.mn.us Date Issued: 01/20/2009
Site Address: 16318 Elm Creek La
Lot: 001 Block: 001 Addition: Fieldstone Creek 3rd Addition
PID: 22-26702-010-01
Use: 16320-22-24-36-38-40 Elm Creek * 2 2 - Z 6 7 ~ 2 - ~ 1 QJ - D 1
Description:
Sub Type: Water Meter
Work Type: New
Description:
Meter Size Meter Tvne Manufacturer Serial Number Remote Number Line Size
2" Omni T2 Sensus 70086094 63776605
Comments:
Fee Summary: Descri to ion Amount Revenue Code
Water Meter $1,550.00 7600-5161
MXU $130.00 7600-5163
Reducing Valve $315.00 7600-5165
Total: $1,995.00
Contractor: -Applicant - Owner:
Genz Ryan Plmbg & Htg
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
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: ign re
PLl NG PERMIT APPLICATION off ce vse only
CITY OF LAKEV ILLS Permit Number
BUILDING INSPECTIONS DEPARTMENT
~ 20195 HOLYOKE AVENUE Received $y
LAKEVILLE, MN 55044
' / ~ 952-985-4440
vi'w~~ .ci.lakeville.tnn.us Date Received
~ , .
i DATE -YOUR E-/MAIL A_DADR))ES~~S
SITE ADDRESS ~ L;~ ~ i ~ ~ (Yl C `~'e~k C..L~~~
TENANT SUITE N0.
THE APPLICANT IS: ? RESIDENT OWNER ? CONTRACTOR
NAME
RESIDENT OWNER ADDRESS
CITY STATE ZIP
DAYTIME PHONE # WHERE YOU CAjN~BE REACHED
COMPANY NAME-~~- E'_1'"I Z /~-~1 QJ`l'~ LICENSE #
ADDRESS ±2 Z ~1~? iit°~-tom,; ice; ~ g~ ~~„I 1
CONTRACTOR CITY 1.,
lY t'1 'a 1 ~ ~ STATE ly ZIP .S 5
OFFICE PHONE # FAX #
CONTACT NAME 1 ~ ~ ' ~ PHONE J
~-,~~r - 1 g
COMMERCIAL ONLY RESIDENTIAL ONLY
? COMM PLMBG SYSTEM ? LAWN SPRINKLER ? Il`rSIDE 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
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 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 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 approval of plans. ^
t~ ~ .
NAME OF APPLICANT (Please Prints " I'°~~~~ Date ~ ~.i
SIGNATi:JRE OF APPLICANT:. c ' "7
PLEASE NOTE: SEPARATE PE N[I"C. ?ARE QUIRED'FOR AN2' BUILDING.I~IELEIA':YICAL ~ ELECTRICAL VF"iJTtii ; - '