Permits - Permit# 03-18P - 2486 Black Lake Road - 1/1/2003CITY OF SPRING PARK
4349 WARREN AVENUE
SPRING PARK, MINNESOTA $5384
952-471-9051
APPLICATION FOR PLUMBING PERMIT
L You may ripply for plumbing permits by mail or in person at the Cky dtfices. PERMS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT REM EM Tnir p]EgKM
CARD &-EQ 9 ON Two iOH SIM
3. Plambint permits may be issued ONLY to licensed phumbing contractors and to property owners
residing in the dwelling.
4. When NW new constraetion or remodeliag Is Involved, a separate building permit must be obtained.
S. All work omit be done In accordance with the State Code requirements.
6. All work must be inspected a" air tested before it is covered. Call 952-U94600. A 2"our notice
required,
INSTRUCTION CA mpkte all items on this application. Compute the permit tee Sign and date the
cc' ifwJd on. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. H you have questions, call
"2-24946M.
Please check one: New
Realdential
JOB SITE:
Owner's Name
Mailing Address
Contractor's Nag
Mailing Address
Repair Replaee
,— Commereial 9
Ngmber
FIXTURE BSMT IST 2ND OTHER FWURE BSMT IST 2ND OTHER
TYPE_ cf. FL. TYPO 17, FI
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1
Plumbiu$ permit Apphca6an
2002 State Statute Yea, This Section Applies
The replaceasent of a BejdMjdr tiab. ft al: aFR1an-. that meets all three of the following requirements:
1) Does Not require modification to deciikal or on service.
2) Has a ttlWMd of $500.00 or less excluding the cost of the future or appliance:; and
3) Is unproved, installed or replaced by the hammer or licensed contractor.
Skip neat section;
H above does nut apply, follow Videfines below:
Cost of Permit $ 13.00
Shute Surcharge $ -AL
Mail In Fee $ 1.50
1. 1.25% Of Cm t[id BdCa* or M_ "'=.n._M Pee :jgo.)
wr/ :.0125
Contract Rice
2. State SSurrh6my ** Add the State Building Code Division
Surcharge to each permit x .0005
Contract Price
or SM, whichever is greater
3. EhldeaSltd1Rman
4. TOTAL !'ERAt[1T In
(Only lea 14a applies&=)
(Add lines 1-3 above)
$ W
* CONTRACT MICE OR JOB COST means the actual or estimated dollar amount charged for the
permitted work including materials, labor, profit, and other Hzed costs, lit is the amount to be charged
to the customer for the work done. Many 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 peradt fee purposes. In the event that there is a dispute on the
anK mt of the Job cost, the City may regaest the submission of a signed copy of the acted contract.
7 * The STATE SURCHARGE is AN of the contract price aader $1,000,000 or $.So, whichever
Is greater. For valuations over $1,000,000 call the Department of Lsspeedonal Services for the price.
The undersigned hereby applies to the City for baumce of a Pivmbing Permit, agrees to do all work In strict
accordance with the ordinances of the City and the regulations of the State of Minnesota, and cerdfies that
MR statements 1081le on this application are complete, true ao d correct.
Applicant's Signature
i
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