Permits - Permit# 04-05P - 3826 Budd Lane - 1/1/2004FR01 01IY uF SFRING Pn'O lwtul w zi au 6.ii• o i+uiiiiyr r
CITY OF SPRING PARK /
4349 WARREN AVENUE
SPRING PARK, MINNESOTA 55384
952471-9Q51
APPLICATION FOR PLUMBING PERMIT
GENERAL INFORMATION
1. You may'apply for plumbing permits by mail or in person at the City offices. PERMITS ARE NOT
VALID U"m YOU RECEIVE A PERMIT. WORK MIST NOT RE _ IJNTH, THE PERMIT
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 budding permit must be obgtbed.
S. All work must be done in accordance with the State Code requirement L
6. All work mast be inspected and air tested before it is covered. Call 952-249-46M. A 24400r notice
required.
MSTgIICIIONS Complete all items on this application. Compute the permit fe& Sipe and date the
certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call
957r249��.
Please check sac; New Addition Repair Replace
Residential T Commercial
ITE: G��G � � /�
Io>l s — sZ. -2 S'
Owncr's Name IMony Number
Mailing Address �� " ''/�
Coatraetor's Name �i Phone Number —
Meiling Address- 4 r1 D
FIXTURE
BCMT i49T 2ND OTHER FIXTURE B3MT 1ST 2ND OTHER
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FROM CITY OF SPRING PARK luau) a �1 �uu� 0-qo/�I- 0.41i1+0. �)uI I'tI�,0,
Plumbing Punk Applicadun
2002 State Statute Yes, This Section Applies
The replacement of a that meeb all throf the following requirements:
1 ) pain require modifleadoa to electrical or Ras servithree of
2) Has a tl+tal..Wd of $500.00 or less excluding the cost of the fixture or appliance; and
3) In improved, installed or replaced by the homeowner or licensed contractor.
Skip next section;
If above does not apply, follow Lnidetines betow:
Cost of Permit S is 00
State Surcharge, S IQ
Mail In Fee S
1, 1.25% Of Cont[actEdcae or
.o12s
Contract Mee
2. sujz-3g& — Add the State Bu' ing Code Division
Surcharge to each permit ac x.0005
Contract Price
or 5.50, whichever is greater
nomr,"', 1
4. TOTAL PERMIT FEE
(Only mail -In applications)
(Add lines 1-3 above)
s
4/0 $
7x�
a
S1 S"f
57E
* CONTRACT PRICE OR JOB COST mean& the actual or estlamted doir amount chtu•ged for the
permitted work including materials, labor, profit, and other fixed costs. It is the saaflnmt to be charged
to the customer for the work done. U any material, equipment, labor, or installation are fttr°ished by
the owner, tenant or any other party the reasonable market value of such items mast be added to the
estimated cost or contract price for the permit fee purposes. In the event that there is a dispute OR the
amount of the job cost, the City may request the submission of a signed copy of the aetaral contract.
** The STATE SURC>3ARGE Is .0005 of the contract price under $1,000,000 or 5.50, whichever
is greater. For valuations over $1,000,00 call the Department of Lupectlonal Services for the price.
The undersigned hereby applies to the City for issuance of a 140mbinR Permit, agrees to do all work in strict
accordance with the ordinances of the City d the regulations of the State of Minnesot& and cer•daes that
all statements made on thb a cation o te, true and correct.
Date
Applicant's Slgnatur
2