HomeMy WebLinkAboutLA104699 PERMIT
Clty Of LakeVllle Permit Type: Plumbing
20195 Holyoke Ave Permit Number: LA104699
Lakeville, MN 55044 Date Issued: 01/25/2008
(952) 985-4440
www. ci.lakeville.mn.us
Site Address: 16374 Elm Creek La
Lot: Block: Addition:
PID:
Use: Fieldstone Creek Third
Description:
Sub Type: Water Meter
Work Type: New
Description: Meter Room---2" Compound Meter, MXU & PRV
Meter Size Meter Tune Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: Description Amount Revenue Code
No Charge $0.00
Water Meter $1,550.00 7600-5161
Reducing Valve $315.00 7600-5165
MXU $130.00 7600-5163
Total: $1,995.00
Contractor: -Applicant - Uwner:
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. A
SEPARATE ELECTRICAL PERMIT IS REQUIRED
Applicant/Permitee: Signature Issued By: Signature
PLUMBING PERMIT APPLICATION ~ offee Use Qnl
~ CITY OF LAKEVILLE Permit Number
BUILDING INSPECTIONS DEPARTMENT
~ 20195 HOLYOKE AVENUE Received By
LAKEVILLE, MN 55044
" 952-985-4440
w~~~r.ci.lakeville.rrm.us Date Received
DATE YOUR~~++E-,M,AIL AD~DRESS~~r
SITE ADDRESS ~ ~ Cil'M ~.M,,+~ ~GIIV~._-r~
TENANT SUITE NO.
THE APPLICANT IS: ? RESIDENT OWNER ? CONTRACTOR
NAME
RESIDENT OWNER ADDRESS
CITY STATE ZIP
DAYTIME PHONE # WHERE YOU CAN BE REACHED
COMPANY NAME_ ' _ h(J2']'U LICENSE #
ADDRESS C'i~.'1~3Z. ° (Z'~.>4 ~ ~C,~ i,~`71> ,
CONTRACTOR CITY STATE ZIP
OFFICE PHONE # FAX #
CONTACT NAME PHONE
COMMERCIAL ONLY RESIDENTIAL ONLY
? COMM PLMBG SYSTEM ? LAWN SPRINKLER ? INSIDE PLBG
PERMIT TYPE ? COMM/MIJLTI-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 q ~ ~ ? REPLACE ? DEMOLITION
JOB DESCRIPTION~1j~eJ1~"v Q-r~~--
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 Job Cost
I-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 I understand this is not a
permit but only an application for a permit and work is not to start without apermit; that the work will 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 ; L's ~ ~ u - Date 1 25 Q
SIGNATURE OF APPLICA ~ w"
PLEASE NOTE:. SEPAI2ATEPER I S RE REQUIR ~ ANY BUILDTG. MECHANIGAL& I'JLECTRICAL WORK
I -
PLUMBING PERMIT APPLICATION PAGE 2
OFFICE USE
SYSTEM TYPE: INSPECTIONS:
~EW ROUGH-IN
ADDITION FINAL
REPAIR ~~RPZ TEST REPORT
DEMOLISH COMBUSTION AIR
REPLACE UNDERGROUND
ALTER/REMODEL
PERMIT FEE:
PERMIT FEE: $
SURCHARGE: $
METER: $ ~
t
REDUCING VALVE: $ ~
MXU $
OTHER: $
TOTAL: $
ISSUED BY: DATE:
COMMENTS:
Revised 01/01/2007