HomeMy WebLinkAboutLA102166 PERMIT
Clty Of LakCVllle Permit Type: Plumbing
20195 Holyoke Ave Permit Number: LA102166
Lakeville, MN 55044 Date Issued: 08/13/2007
(952) 985-4440
www. c i. l akevi l le. mn. us
Site Address: 16413 Elm Creek La
Lot: Block: Addition:
PID:
Use:
Description:
Sub Type: Water Meter
Work Type: New
Description:
Meter Size Meter Tune Manufacturer Serial Number Remote Number Line Size
2" Compound InvenSys 68165495 61922452
Comments:
Fee Summary: Description Amount Revenue Code
Water Meter $1,550.00 7600-5161
Reducing Valve $315.00 7600-5165
MXU $130.00 7600-5163
Total $1,995.00
Contractor: _ Applicant - Owner:
Genz Ryan Plmbg & Htg D R Horton
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 Issti~d By: Signature
t PLUMBING PERMIT APPLICATION office use only
~ to Z t(oto
CITY OF LAKEVILLE Permit Number
BUILDING INSPECTIONS DEPARTMENT
~ -20195 HOLYOKE AVENUE Received By
i' LAKEVILLE, MN 55044 ~ OD
952-985-4440
~ c~~~.ci.lakeville.mn.us Date Received
DATE YOUR E-MAI ADDRESS
SITE ADDRESS
TENANT SUITE NO.
THE APPLICANT IS: ? RESIDENT OWNER CONTRACTOR
NAME
RESIDENT OWNER ADDRESS
i CITY STATE ZIP
DAYTIME PHONE # WHERE YOU CAN BE REACHED
COMPANY NAME LICENSE #
ADDRESS
CONTRACTOR CITY STATE ZIP
OFFICE PHONE # FAX #
CONTACT NAME PHONE
COMMERCIAL ONLY RESIDENTIAL ONLY
? COMM PLMBG SYSTEM ? LAWN 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 f REMODEL
TYPE OF WORK
? REPAIR ? REPLACE ? DEMOLITION
~ JOB DESCRIPTION ~~~~~~iy
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: $
Exam le: $12 000 Job Cost
P
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 i% = 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 ut 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 pl
NAME OF APPLICANT (Please rnt Date ~ ~
SIGNATURE OF APPLICANT: `T~ ~ y
PLEASE NOTE: SEPARATE PERMITS ARERI;QUIREll FOR--ANY BUILDING, M>?CHANICAL &ELECTRICAL WORh-
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
PERMTT FEE:
PERMIT FEE: $
SURCHARGE: $
METER: $
REDUCING VALVE: $
MXU $
OTHER: $
TOTAL: $
ISSUED BY: DATE:
COMMENTS:
Revised O1JOl/2007