Permits - Permit# 02-02P - 2425 Black Lake Road - 1/1/200237
CITY OF SPRING PARK
r4349 WARREN AVENUE 4.
._. .
SPRING PARK, MINNESOTA "55384 .,
952-471-9051
APPLICATION FOR PLUMBING PERMIT
RECEIVEry____�
MAY 1 3 2002
CITY OP SP.
GENERAL INFORMATION
1. You may apply for plumbing permits by mail or in person at the City offices. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT
CARD IS POSTED ON THE JOB SITE.
3. Plumbing permits may be issued ONLY to licensed plumbing contractors and to property owners
residing in the dwelling.
4. When any new construction or remodeling is involved, a separate building permit must be obtained.
5. All work must be done in accordance with the State Code requirements.
6. All work must be inspected and air tested before it is covered. Call 952-2494600. A 24-hour notice
required.
INSTRUCTIONS Complete all items on this application. Compute the permit fee. Sign and date the
certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call
952-2494600.
Please check one: New Addition Repair Replace
Residential Commercial
JOB SITE: 5La CK L.a.-Ke g e4_
Owner's Name c,--- Phone Number 3/71—,92,9S
Mailing Address 5c�M e
Contractor's Name lJP 1 a_ v.- Phone Number A3- `17-$=0.296
Mailing Address 3/S J-un ec� u la n e
FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER
TYPE FL FL TYPE FL FL
Plumbing Permit Application
2002 State Statute Yes, This Section Applies
The replacement of a Residential fixture or appliance,that meets all three of the following requirements:
1) Does not require modification to electrical be gas service.
2) Has a total cost of $500.00 or less excluding the cost of the fixture or appliance; and
3) Is improved, installed or replaced by the homeowner or licensed contractor.
Skip next section;
If above does not apply, follow guidelines below:
Cost of Permit $ 15.00
State Surcharge $ .50
Mail In Fee $ 1.50
1. 1.25% Of Contract Price* or Minimum Fee ($35.00)
5'00 x .0125
Contract Price
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit x .0005
Contract Price
or $.50, whichever is greater
3. Postage and Handling
4. TOTAL PERMIT FEE
(Only mail -in applications)
(Add lines 1-3 above)
,5—0
* CONTRACT PRICE OR JOB COST means the actual or estimated dollar amount charged for the
permitted work including materials, labor, profit, and other fixed costs. It is the amount to be charged
to the customer for the work done. If any material, equipment, labor, or installation are furnished by
the owner, tenant or any other party the reasonable market value of such items must be added to the
estimated cost or contract price for the permit fee purposes. In the event that there is a dispute on the
amount of the job cost, the City may request the submission of a signed copy of the actual contract.
** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50, whichever
is greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in strict
accordance with the ordingnces of the City and the regulations of the State of Minnesota, and certifies that
all statements made on this application are complete, true and correct.
% � �S`
Applicant's Signature Gam---- 4, Date 0 2
2