Permits - Permit# 5-13-95 - 2452 Black Lake Road - 1/1/1995E1-471-9055 CITY OF SPRING PARK 842 'lj� � - - --
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rMY OF SPRING PARK APPLICATION FOR PLUM D4G PERAUT
Box 452 (4349 Warren Avenue)
Spring Park, MN 55384
CEINTERiL LNFOR1b-1I0N
1. You may apply for piumbing permits by mail or in person u the City offices.
Z. Per=t cards will be sent by return mail after a review is completed. PERMITS ARE NOT VALID
liNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERIvSIT CARD IS
POSTED ON THE JOB SITE.
plumbing permits may be issued ONLY to licensed plumbing contractors and to propery owners :esidiag
in he dwelling.
Whea any new construction or remodeling is involved, a separare. building permit must be obtained.
�. All work must be done in accordance with the. Stam'Code. requirements.
6. Adl work must be inspected and air tested- befom it is covered. Cal1.473-7357.24-hour notice reauL. ed.
Tnsa uctions Complete all items on this application..Compute..the permit fee. Sim and dart
to c.-zzinNC cation. INCOMPLETE APPLICATIONS ML NOT BE'PROCESSF-D- If you have
Tiesdons, call 473-7357.
Please ciiecx one: New _ Addition Repair Replace
Residential Commercial
JOB SITE.• 2452 )LAL-K- L(AILQ- ZiP'
Owner's Name_ `76nO •A6tivv,66V TelephoneNTumber.:
Mailing Address; City: Zip:
Contractor'sName: SP\-01u—� r1 C TeieQhoneNumiier. ')o b
MailingAddress: l6 z, \AVZ. b TA City: J►k Zip:) Z,
PLUMM NG FIXTURE SCHEDULE,
PL�URr 1 BS�IT ; 111jT f 3ND OTHER: FIXTURE BSX7 1ST
r �•pF ;z I FL TYPE FL
Water Closet
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I
Floor Drains
Lavatory
Sewer Ej=or
Bathtub
I
L.-mdq Tay
Shower
t
R'asher
Kitchen Sink
'4Vatet . Heater . ,'
Disposal
.Water. Soi[euer,:
Dishwasher
= Wet Bar
Sillcocks j—F-
I
I Misc. (list)
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FL i
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PERMIT'EE CALCULATION
1. 1.25 % of Contract Price* or Minimum Fee (J35.00)
2b'Sb , V^ x .0125
(contract price)
State Surcharge. ** Add the State Building Code Division
Surcharge to each permit. 2bS x .0005
(contract price)
$ 3'�' �� ___
S i.3 ''--
or $.50, whichever is greater
3. Posta e and Handlin (Only mail -in applications} $ 1.50
+. TOTAL PERMIT FEE (Add lines 1-3 above) 3-ZT�
CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pe= nit
work including materials, labor, profit, and other ftxed costs. It is the amount to be charge-d to the
customer for the work done. If any material, equipment, labor, or installation are fiunished by the OwnC .
tenant or any other parry the reasonable market value of such items must be added to the estimated c05i
or contract price for permit fee purposes. In the event that there is a dispute on the amours[ of the job cos.,
the City may request the submission of a signed copy of the actual contract.
The STATE SURCHARGE is .0005 of the contract price wader $1,000,000 or 5.50 - whichever. :s
greater. For valuations over $1,000,000 call the Departtuent of Inspectional Services for the price.
The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do aii
work in strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all statements made on this application are complete, rsue and
correct. /
Applicant's Signature: V1�t� Date
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