Permits - Permit# 02-01 - 4317 Channel Road - 1/1/2002CITY OF SPRING PARK
Box 452 (4349 Warren Avenue)
Spring Park, MN 55384
APPLICATION FOR PLUMLNG iG PERMIT
GENERAL 2109—.rii,Ar0N
1. You may apply for plumbing permits by mail or in person at the City offices.
2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT VALID
UNTIL YOU RECEM A PEIL'YII'T. WORK MUST NOT SECiIN UNTIL THE PERMIT CARD IS
POSTED ON THE JOB SITE.
3. Plumbing permits may be issued ONLY to liotused plumbing contractors and to property owners residing
In the dwelling.
4. When any new construction or remodeling is involved, a separate buliding permit must be obtained.
$. All work must be done in accordance with the. State Coda requirements:
6. All work must be tAgggied and air tested:.befots iris covered..• Call.•a?3-7357. 4-hoar notice required.
-Instructions Complete all items on this • application: ' ,Compute,,the. permit .fee... Sign.. and date
the certification. INCOMPLETE APPLICATIONS WILL NOT BE' -PROCESSED. If you have
questions, call 473-7357.
Please check one: New Addiaon Repair X Replace
= Residential Commercial
HEADLEE,JOHN
JOB S1'i 4317 CHANNEL ROAD Zip:OwII 'errs N=e: SPRING PARK, MN 55384 TelephoneNwmher:
Mailing Address: (952) 471-1091 City: Zip: _
Coniracto r'sName: o. TeiephoaeYumber• 2 2- - 33
MailingAddress: 9R05 , So. City: Wis . Mr'( Zip: 55406
FIXTURE
TYPE
BSMT
IST
FL
ZND
FL
OTHER-
MX•TURI~'
TYPE
BSMT'
1-ST
FL
2Ni7•
FL
OTHER
Water CIoset
I
Floor Drains
Lavatory
Sewer Ejector
Bathtub
Laundry Tray
Shower
er ,
Kitchen Slak
`.'VMr.;Hea�r,
.
Disposal
Oater•�o
Dishwasher
Wmt Bar
SWcocksMisc.(fit)
T
F
KBNa FEE CALCULATION_
1. 1.25 % of Cgntract P ce* or bjb9M= Ea (Sligg)
4ocV0 x .0125 ::3 5 . vc�
(contract price)
2. State SgM rgg. ** Add the State Building Code Division SU
Surcharge to each permit. x .0005 $
(contract price)
or $.50, whichever is greater
3. Pom a and Handling (Only mail -in applications) $ 1.50
4. TOTAL PERMIT FEE (Add lines 1-3 above) $ _ 37,00
* 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 fu zished by the owner,
tenant or any other patty the reasonable market value of such items must be added to the estimated cost
or contract price forpermit 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 $.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 accoqdqnce with the ordinances of the City and the regulations of the State of
Minnesota, and cc 'f s that all statements made on this application are complete, true and
correct. i
Applicant's Signature:
Date: / D 7