HomeMy WebLinkAboutLA092095 PERMIT
City of Lakeville Permit Type: Sewer /Water
20195 HOLYOKE AVE Permit Number: LA092095
LAKEVILLE, MN 55044
(952) 985-4440 Date Issued: 06/14/2006
Site Address: 16705 EAST LAKE DR
Lot: Block: Addition:
PID:
Use:
Description:
Sub Type: Water Install Only
Work Type: New
Description: Applicant Must Call for Insp.
Meter Size Type Manufacturer Meter Nbr Remote Number Line Size
Remarks:
Fee Summary: Surcharge (.50) 0.50 1000-2127
Water Install Only 84.50 1000-4153
$85.00
Contractor: -Applicant - OWner:
DASEN CONTRACTING
24245 NATCHEZ St. Lic.:
LAKEVILLE, MN 55044
(952)461-2100
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
- C~ffic U`ae 1
s SEWER AND WATER PERMIT APPLICATION ~
r _ _ ,
CITY OF LAKEVILLE Permit Number
~ BUILDING INSPEC"PIONS DEPARTMENT
i , s.~. ~ ' ~ 20195 HOLYOKE AVENUE Received By
••::>::::>:<':;"?'>:s:':,:::;:'`~ LAKEVILLE, MN »044
~•:•:::>::>~•:<::•~:::;~z% 952-985-4440
~ / Date
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DATE ~ " YOUR F,-MAIL ADDRESS
SITE ADDRESS ~ lt.~ ~Oti-~
"TENANT SIJI"TE NO.
THE APPLICANT IS. ? RESIDENT OWNER ? CONTRACTOR
NAME
RESIDENT OWNER ADDRESS
CITY STATE ZII'
DAYTIME PHONE # WHERE YOU CAN BE REACHED
COMPANY NAME LICENSE
ADDRESS ~ NG~I~--L-
CONTRACTOR CrrY STATE ''1~N z~~~
t~?~
CONTACT NAI~lE G 4 FAX # ~S L ~ ~ ~~i~~D fG' _
DAYTIlVIE PHONE # tL'HERE YOU CAN BE REACHED (/Z '~LfI ZOS
~
TYPE FEE
? SEPTIC SYSTEM + COj 1N"I'Y SEWER FEE 74. ~0 + .50 + 40.00 (COUNTY FEE)
NEW !REPAIR !REPLACE
? SEWER/WATF.R CONVERSION 84.50 + .50
? SEWER CONVERSION 84.50 + .50
PERMIT TYPE C7 WATER CONVERSION 84.50 + .50
? COMMERCIAL 1% JOB COST + SURCHARGE
(INCLUDES WATEI2lFII2E LINE) $40.00 MINIMUM
(SURCHARGE =JOB COST X .0005)
? MISC (INCL,UDES PRIVATE SEWER 39.50 + .50 (MINIMCTM)
REPAiR/NOT SEPTIC SYSTEM) (INSTALL MAhTHOLES, ETC.)
FOR: ? Residential ? Commercial ? Industrial
Is Street Excavation necessary? ? YES ? NO
If so, has Escrow or Bond been paid & Street Excavation Permit applied for'? U YES ? NO
(Call Enginearnlg Department, 952-985-4500)
COMMERCIAL FEES
JOB COST: $
Example: $12,000 Job Cost
1% of cantract cost plus $12,000.00 x 1% _ $120.00
Surcharge = (Contract Cost x .0005) + $12,000.00 x .0005 = 6.00
TOTAL = TOTAL $126.00
Minimum of $40.00 ($39.50 + .j0 surcharge)
NAME OF APPLICANT (Please Print
APPLICANT'S SIGNATURE: ~ DATE
SEWER AND WATER. PERMIT APPLICATION PAGE 2 ~
OFFICE USE
WORK TYPE: INSPECTIONS:
coNEW STREET DRAINTILE
ADDITION HYDROSTATIC TEST
REPAIR CONDUCTIVITY TEST
DEMOLISH BACTERIA TEST
REPLACE WATER LINE
ALTER/REMODEL SEWER LINE
STORM SEWER
FLUSHING
OTHER
y FINAL
PERMIT FEE:
PERbIIT FEE: $
SURCHARGE:
WATER UNIT
SEWER UNIT $
METRO SAC $
OTHER: $
d C.~
TOTAL: $
APPROVED BY: DATE:
COMMENTS:
Revised 05124/2006