Permits - Permit# 94-11 - 2478 Black Lake Road - 1/1/1994CITY OF SPRING PARK
P. O. BOX 452 APPLICATION FOR PLUMBING
SPRING PARK, MN 55384 P E R M I T
********* l Information
General Infozmtion ,
1. You may apply for plumbing permits by mail or in person at the City offices.
2. Mailed in application are subject to the postage and handling fees shown below, Permit Cards will
be sent by return mail the same day the application is received.
3. Permita are not valid until you receive a permit card.
4. Work must not begin until the permit card in posted on the job site.
S. Plumbing permits may be issued to state -licensed plumbers or to homeowner/occupants who intend to
actually perform their own work in their home. 1
6. When any new construction or remodeling is involved, a separate building permit must be obtained.
7. All work must be done in accordance with the State Building Code Requirements.
S. All work must be inspected before it is covered. Call for inspections 24 hours in advance 1
(473-7357).
Instructions. Complete all items on this application. Compute the permit fee. Sign and date the
l
certification. Incomplete applications will not be processed. If you have any questions, cell
473-7357. 1
WALK-IN PERMITS --Apply at City Offices, 4349 Warren Ave.
MAIL -IN PERMITS --Enclose Pee --Mail toi P. 0. Box 452, Spring Park, MN 55384
JOB SITE ADDRESS 214'1? 6 LA C-1c t,4 K E F_ 1>
Occupancy Type: V Residential Commercial
Work to be Performed by: _� Licensed Contractor Owner/Occupant
OWNER I S NAME D(r'r ter(5 CA J1 W E L L Telephone No.
Mailing Address P4-)9 BLAc k- L fA Y_E k
PLUMBER'S COMPANY NAME --7 0m s QuA-L) r- Plus»,d-d6 Business No. F92 - &Slo �
Mailing Address pa boy a I ?- p ssE 0, m .J SS34 %
Master Plumber's State License No. 38'15'P!h City Cert. No.
PLUMBING FIXTURE SCHEDULE
(Show Number of Fixtures of Each Type on Each Floor)
TIXTURE TYPE
BSMT.
lat Floor
2nd Floor
Other Floors
FIXTURE TYPE
SSKP.
1st Floor
2nd Floor
Other Floor
water Closet
/
Laundry Tray
Lavatory
I
Washer
Bathtub
Water Heater
Shover
/
Water Softner
Misc. Fixtures:
(List)
Rlechen Sink
Disposal
-_
Dishwasher
Wet Bar
Sillcocks
Floor Drains
A
-
Sump Pump
IXTURES 3
Sewer L actorF::J
PERMIT FEE CALCULATION
1. Fixture Fee. The minimum permit fee is $25.00.
Compute number of fixtures 3 x $4/fixture $ S.ao
2. State Surcharge $ .50
3. Postage and Handling (Only for Mail -in applications) $ 1.50
4. TOTAL Permit Fee (Add lines 1-3 above) $ '2 -?,0o
The undersigned hereby applies to the City of Orono 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 Minnesota sear'•
Building Code, and certifies that all statements made on this application are complete, true and
correct.