HomeMy WebLinkAboutLA097495 - PL PERMIT
City of Lakeville Permit Type: Plumbing
20195 Holyoke Ave Permit Number: LA097495
City of Lakeville, MN 55044 Date Issued: 01/08/2007
(952) 985-4440
www.ci.lakeville.mn.us
~ Site Address: 16490 ELM CREEK LA 5
Lot: Block: Addition:
PID:
Use: FIELDSTONE CREEK 2ND
Description:
Sub Type: Water Meter
Work Type: New
Description: METER ROOM
Meter Size Meter Tvpe 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
MXU $130.00 7600-5163
Reducing Valve $315.00 7600-5165
Total: $1,995.00
I
Contractor: -Applicant - ~Wner:
GENZ RYAN PLMBG & HTG 0
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 &
i 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 office use only
CITY OF LAKEVILLE Permit Number
/l' ~ BUILDING INSPECTIONS DEPARTMENT
20195 HOLYOKE AVENUE Received By
LAKEVILLE, MN 55044
952-985-4440
www.ci.lakeville.mn.us Date Received
DATE / ' ~ / YOUR E-MAIL ADDRESS
SITE ADDRESS~~ Ci ~ C~'~ ~ r~~_~~~'
TENANT_ Jr~Y~~7` rti- ~ ~ C) !Y"~.. SUITE NO.
THE APPLICANT IS: RESIDENT OWNER CONTRACTOR
NAME
RESIDENT OWNER ADDRESS
CITY STATE ZIP
DAYTIME PHONE # WHERE YOU CAN BE REACHED
COMPANY NAME p 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
(A~ailable on-line Residential Permits Available on-line
NEW ~ ADDITION ALTER /REMODEL
TYPE OF WORK
-REPAIR REPLACE DEMOLITION
a
JOB DESCRIPTION ~ `l ~ ~ ~7 ~ ;
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
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
i (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 an electrical 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 Building Codes; that I 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.
NAME OF APPLICANT (Please Print) Date ~ - ~ ~
SIGNATURE OF APPLICANT:
PLEASENOTE: SEPARATE PERMITS ARE REQUIRED FOR ANl' BUILDING, MECHANICAL S ELECTRICAL WORK
i
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: $
TOTAL: $
ISSUED BY: DATE:
COMMENTS:
Revised 01101 /2007