HomeMy WebLinkAboutLA102973 PERMIT
City of Lakeville Permit Type: Plumbing
20195 Holyoke Ave Permit Number: LA102973
Lakeville, MN 55044 Date Issued: 09/17/2007
(952) 985-4440
www. ci.lakeville.mn. us
Site Address: 17070 Embers Ave
Lot: Block: Addition: Cornerstone Lake
PID:
Use: Cornerstone Lake
Description:
Sub Type: RPZ
Work Type: Repair
Description: RPZ Rebuild
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: Description Amount Revenue Code
PL-Commercial (Minimum) $39.50 1000-4152
Surcharge (.50) $0.50 1000-2127
Total: $40.00
Contractor: -Applicant - ~Wner:
Dakota Plumbing & Heating
575 Mennehaha Ave W
St Paul MN 55103
(651) 454-6645
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. A
SEPARATE ELECTRICAL PERMIT IS REQUIRED
' Applicant/Permitee: Signature sued By: Si ature
~
f PLUMBING PERMIT APPLICATION
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rT CTI'Y OF LAKEVILLE Pmnit Nund~r
BUII.DING INSPECTIONS DEPARTMENT
20195 HOLYOKE AVENUE Received $Y
LAKEVILLE, MN 55044
952-985-4440
www ci lalceville mn.us Die /
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THE APPLICANT IS: ? RESIDENT OWNER CONTRACTOR
NAME Ct~v vv~ S L-~ p4cx~ tares)
ADDRESS N Ste" Sr S~.'T~ ~ tod
RESIDENT OWNER ~,.,~d ~
CITY ~.r+ ? s STATE ~
DAYTIME PHONE # WHERE YOU CAN BE REACHED G I ~ -3Fs t - Tr G po
COMPANY NAME `77~-- ~ LICENSE # °-t~ ~
ADDRESS S-7 S r~ `"-t ~
CONTRACTOR cmt _ sT sTATE ~ zIP ssY ~3
CONTACT NAME '°S ~ t'om''"'
DAYTIME PHONE # WHERE YOU CAN BE REACHED ~S t "YS 4 -G G ticS°
COM11L$RCIAL ONLY RESIDENTIAL ONLY
D COMM PLMBG SYSTEM ? LAWN SPRINKLER 0 INSII~ PLBG
PERMiT TYPE D CAN-T~p'~'Y ? WATER SOFTENER CONVERSION
LAWN SPRINKLER D WATER HEATER ? ADDN/REPAIIt
? FQ2E SPRINKLER ? MLSC
PZ Available on-tine Resfdentral pa~nixr.4v+ailabla an-line
? NEw ? ADDITION ? ALTER !REMODEL
TYPE OF WOBK
~Pp~ D REPLACE ? DEMOLITION
JOB DESCRIPTION +
RESIDENTIAL. FEES:
R,epairs or Remodel 540.00 (39.50 + .50 surchmge) Water Softener 8t Water Heater S 15.00 (14.SO + .5o serge)
COMMERCIAL FEES:
JOB COST: S
Example: sizooo aob cwt
1-1/2% of ~ntract cx?st up to 510,000 and 510,000.00 x 1.5% = 6150.00
1% of cost above 510,000 plus surchar~. + S 2,000.00 x 1% = 20.00
(Surcharge =Contract Cost x .0005) + S 12,000 x .0005 = b.00
_ TOTAL 5176.00
Minimum of 540.00 (39.50 + .50 surcharge)
NO.O METERS SIZE OF METER LOCATION OF METER
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Gt--~--"
t s Si ature l Date ~
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PLUMBING PERMIT APPLICATION PAGE 2
OFFICE USE
SYSTEM TYPE: INSPECTIONS:
NEW ROUGH-IN
ADDITION ~~FINAL
REPAIR RPZ TEST REPORT
DEMOLISH COMBUSTION AIR
REPLACE
ALTERIREMODEL
PERMIT FEE:
PERMIT FEE: $
SURCHARGE: $ ` y'~
METER: $
REDUCING VALVE: $
MXU $
OTHER: $ _
TOTAL: ~
ISSUED BY: ~ DATE:
COMMENTS:
Revised 03101/200~L