HomeMy WebLinkAboutLA100019 -PL PERMIT
City of Lakeville Permit Type: Plumbing
26195 Holyoke Ave Permit Number: LA100019
Lakeville, MN 55044 Date Issued: 05/23/2007
(952) 985-4440
www.ci.lakeville.mn.us
Site Address: 16492 Elm Creek La
Lot: Block: Addition:
PID:
Use:
Description:
Sub Type: Comm/Multi-Family Lawn Sprinkler 0 Plumbing
Work Type: New
Description: Doghouse for Fieldstone Creek
Meter Size Meter Tvpe 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
Water Meter $350.00 7600-5161
MXU $130.00 7600-5 ] 63
Reducing Valve $250.00 7600-5165
Total: $770.00
I
Contractor: -Applicant - ~Wner:
PLYMOUTH PLMBG iNC ,
i 12L70 43RD ST. NE
ST. MICHAEL, MN 55376
(763) 533-4357
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
A licant/Permitee: Si nature` Issued B : Si nature
PP g Y g
PLUMBING PERMIT APPLICATION office use only
CITY OF LAKEVILLE PemutNumber
BUILDING INSPECTIONS DEPARTMENT
i'. ~ 20195 HOLYOKE AVENUE Received By
L 4
AKEVILLE MN 550 4
i >
52- 8 -444
9 9 5 0
www.cilakeviile.mn.us Date Received
DATE S 12Z I O '7 YOUR E-MAIL ADDRESS
SITE ADDRESS 11.Q~19 ~ ~ ~'~G.l~ LQ,~,~_
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 !~1 w~Y,,,.y,,,~r~r~ Pl1nc. ~ 1~E-t~ .LICENSE # 3~t ~ 2
ADDRESS l 2t'1 d ~-13rc1.. Sa- 1~1~
CONTRACTOR CITY ~ . kY\~ Lam. r. ~ STATE Wt 1~l ZIP ~'S 3'110
OFFICE PHONE # `T lea - Ll4 lo' L.Q l S'~b FAX # 'lip 3 " I-(q to - (o Zb d
CONTACT NAME 01~..,rv~~,~~y~y-~ 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 /REMODEL
TYPE OF WORK
? REPAIR ? REPLACE ? DEMOLITION
JOB DESCRIPTION t1¢ar r~•;, -~-v i v~Sar-t.~~- 1~ Z... ~ 1 K°~ S V~-"fi o ~
RESIDENTIAL FEES:
Repairs/Remodel or Water Heater $40.00 (39.50 + .SO 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
(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
~2~ irr.
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 understandthis 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) ~~Q~y~ ~r.~r?~y~ Date S Z2 1
SIGNATURE OF APPLICANT: ~1~
- -
I 'I'LEASENOTE: SEPARA"TE PC S A _ REQUIRE FOR ANY BtiILDt:YG, MECIYANIt 11 &ELECTRIt V ~~Y)RK
- _ -
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: $
c~
METER: $ ~
REDUCING VALVE: $
MXU $ t'.
OTHER: $
TOTAL: $ ~ ~ C1
ISSUED BY: DATE: ~ 3 -C?
COMMENTS:
Revised 01/01/2007
i