HomeMy WebLinkAboutPlumbing Permit 12-0019 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED Z ! 1 Z
ADDRESS /N I. J€ f -PA-S -eR,S,,
OWNER CONTR.
PHONE NO. PERMIT NO. — oo /9
❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
❑ FINAL ❑ PLUMBING FINAL ❑ GASL NE AIR TST
❑ SITE INSPECTION ❑ MECH FINAL A l� E
COMMENTS:
• ' al l .' , '
X WORK SATISFACTORY, PROCEED
❑ CORREC • ,, TION AND PROCEED
❑ CORR; ' ORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ' Owner /Contr:
CALL 447 -9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
p RI Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
.h.S'NES:0 I. Blue File
2. Gold City PERMIT NO. /Z ._.- l GI
3. Yellow Applicant
(Please type or print and sign at bottom) e /
ADDRESS /53 9 j ZONING (office use)
8
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
WNE 75C) ( R Ed � o ree,n, (Phone) - 350-60'0)5
(Address) SCJL►iYl'Pi j r ■ dv 1- -V..p ) i i 1 U S S c� 9- .
APPLICANT Champion Plumbing
(Name) # 61770 -PM (Phone)
651 - 365 -1340
(Address) 3670 Dodd Rd.
(Address) Eagan, MN 55123 (City) (Zip Code)
(Contact Person) K t s D (Phone)
APPLICANT SIGNATURE DATE /'a 1 — 1)
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rou.h
Dishwasher ` 4.
Floor Drain a er o ` ener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi - family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 Cost $ cD•+.. Building Permit #
"SURCHARGE" has been extended
until lune 30, 2013, PLUMBING PERMIT FEE $ .
The minimum surcharge for a STATE SURCHARGE $ .50
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ S ti, °
This Application Becomes Your Building Permit When Approved Paid 91 co R pt N . (.. f, V 1
Date By
Buildinz Official Date 1.✓" .1 2 c ,
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
/07—O3/