Permits - Permit# 4-29-99 - 2452 Black Lake Road - 1/1/1999CITY OF SPRING PARK APPLICATION FOR PLUDVIBLN- G PERMIT
Box 452 (4349 Warren Avenue)
Spring Park, MN 55384
GENE AL P'FORASTION
1. You may aimiy for piumbing permits by mail or in person at the City offices.
2 Pe:mic taros will be sent by re urn mail after a review is compieted. 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 piumbing contractors and to property owners residing
in the dweiling.
4. When any new construction or remodeiing is invoived, 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 insnec:ed and air tested before it is covered_. Call 473-7 57_24-hour notice required.
Instructions Complete all items on this application_ .Compute. the permit fee. Sign and date
the certification. I2NC0i)vfPLETE APPLICATIONS `V'IL L NOT BE PROCESSED. If you have
questions, tail 473-735 7 .
Please check one: New Addition Repair Replace
j_ Resideariai Commercial
JOB SITE: `t ���, I G« K� `� ram' Zip:
Owner's Name: Telephone Number:
Mailing Address: Sys ' Q�e-� � /�/ City: S a� Zip: �Sy/
Contraczor'sName: ��r- U VAt Te.ep ne�iumber. �/ ---It 7-1 Sj�L
Mailing Address: — c� �S�I City: ►'V 1) �� Zip- .S`� ti `6
PLUMBL fG FIXTURE SCHEDLZLE
Fi =.1 -c 11 BSMT iST 13ND I OTHER: (
TypE
FIXTURE
TYPE
BSMT
1ST
FL I
2NII i OTHER
FL.
.Floor Drams I.
i
Wares Closet
Lavatory
I /
I
Sewer Ejector
I (
Laundry Tray
Bathtub
I
I
Washer
Shower
I
Water:. Heater .`
I
Kitchen Sink
I
Water Softener _-
Disposal
I I
(
Wee: Bar
I
Duwasher
I
I
Sillcocks
I I
I
I I
lmhc. (list)
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PERMIT FEE CALCULATION
1. 1.25 % of Contract Price* or Minimum Fee 635.00)
—,Cy. x .0125
(contract price)
2. State Surcharge. ** Add the State Building Code Division
Surcharge to each permit. x .0005
(contract price)
$ A13 7 S'
or $.50, whichever is greater
3. Postage and Handling (Only mail -in applications) $
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ yS- Sd
* 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 parry the reasonable market value of such items must be added to the estimated cost
or contract price for 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 S.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 ordinances 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.
Applicant's L�✓"�- Date:
App b