2005-P09381 - plumbing - Laserfiche WebLink

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,�y�23242S �/� �). ? Minnesota Department of Labor and Industry �{V'�� O 62 Construchon Codes and Licensing Division ,��lry � '�a L ti I Engineering and Plumbing Unit . � 443 Lafayette Road N.,St.Paul,MN 55155-4343 � W Main: (651)284-5005 �p p �:� EngineeringlPlumbing Unit: (651)284-5067 � W , , , , , Minnesota Relay Service: (651)297-4198 �' � - - - Fax: (651)284-5748 www.doli.state.mn.us ��' �, PLUMBING PLAN REVIEW APPLICATION �� ' '0 New Construction ❑ Food service/bar/lod �n Choose one of the following: � ❑ Addition/Rcmodel ❑ Swimmin or s a ool o Building Sewer and/or Water SEWER WATER Service Onlv `�- New municipal � New municipal (This fee applies when no interior ❑ Existing municipal ❑ Existing municipal Plumbing is to be installed). � ❑ New on-sitc septic system ❑ New private well $150 flat fee ❑ Existin�on-<:ir��sc tic system ❑ �;xistin rivate well Plumbing System - OR- � • � (Water distribution and drain/waste/vent systems within the Project namc: -� "`.i�,`j7;� building,and water and/or sewer Project street address: 2(c��Q �E�� PKW�I service connections,if applicable). City/township/county: � �L � This portion of the fee is based on total number of drainage fixture units Name: � ' , (DFU) Mailing /D3n� �/o's a.,..� �✓ a. 25 or fewer DFU $150 b. 26 to 50 DFU �250 address: � c- -- a 51 to 150 DFU $350 � d. 151 to 249 DFU $500 Phone: �y�; j''�`f"��'a e. 250 or more DFU: multiply$3 times number of DFU to a Name: �• � z' maximum of$4,000 Mailing S S� .�_ W��2� � v Total DFU:�7�T $� address: �, ��- ,� lnterceptors/Separators , (grease interceptors,flammable f honc: �� , _ �� '� waste interceptors,etc...) $ --�,.� • � $70 per design � 'Co avoid dclay�s, ;�1.<<<sc �revidc the following information: ❑ Storm Drainage System ❑ Utility Site Ylan(if new services are to be installed) $150 ❑ Floor Plan ($150 minimum) m� ❑ Roof Plan(if internally piped roof drains are proposed) - �R - ❑ W ater Riser Diagrams $50 per internal roof drain opening ❑ Soil,Waste and Vent Riser Diagrams ($500 mag) $ ❑ Plumbing Specifications and/or plus Please see Ya e 2 or a ttetailed descri tion o each item $70 per storm water interceptor, separator,or catch basin design $ I certify that this plumbing system was designed in accordance with the Minnesota Plumbing Code(as amended) TOTAL FEE $�iQ to the best of my abilities,and I agree to forward the Report OPTIONAL• on Plans to the installer of the system. ❑ Accelerated review(Total Fee x 2) � ��' �, 3�� Review completed within IS business $� I�(� � '��`��—� da s or%o submitted ee re unded. �— Signature MN License Number Check or money order must be made payable to ,�--� ,.,n (if applicable) "Department of Labor and lndustry". Mail to: ��' �� LJ`�` Department of Labor and Industry,Financial Name Print or T e Services,443 Lafayette Rd N. St.Paul,MN 55155. Retumed checl�s aze sub'ect to fees M.S.604.113,subd.2 .