HomeMy WebLinkAboutLA196411 PERMIT
City of Lakeville Permit Ty�e: Mechanical
20195 Holyoke Ave Permit Number: LA196411
Lakeville, MN 55044
(952)985-4440 �k L R 1 9 6 4 1 1 �K
www.lakevillemn.gov Date Issued: 10/05/2021
Site Address: 5630 177th St W
Lot: 001 Block: 075 Addition: Section 11 Twn 114 Range 20
PID: 22-01100-75-010
Use:
* z2 — f� 1 1 (� QJ - 75 — (� 1 (� *
Description:
Sub Type: Heating/Air Cond
Work Type: Replace
Description: Furnace&Air Conditioning Replacement
Comments:
Fee Summary: Description Amount Revenue Code
ME-Residential (Minimum) $40.00 1000-4154
Surcharge- $1.00 $1.00 1000.2127
Total: $41.00
CO11tPaCtOP: - Applicant - �Wner:
Total Home Solutions Country View Ltd Ptnshp
1008 Prospect Pointe Rd %Dh Gustafson Company
Jardan MN 55352 14500 Burnhaven Dr Ste 155
(952)200-3982 Burnsville MN 55306
I HEREBY AGREE THAT THIS WORK WILL BE PERFORMED ACCORDING TO: (1)THE APPROVED PLANS&
SPECIFICATIONS;(2)THE APPLICABLE CITY ORDINANCES&CODES;AND(3)THE MN ST.ATE BUILDING CODE.
Please provide a minimum of a 24 hour notice to schedule inspections.BUILDING iNSPECTIONS: (952)985-4440, 8 am -4:30 pm, M-F
ELECTRICAL INSPECTIONS: Call Brian Grey at(507)381-1791,7-8:30 am,M-F to schedule appointments
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Applicant/Permitee: Signature Issued By: Signature
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Ot7ice Use Only
MECHAN[CAI.PFRMIT APPI,ICATION --.- '
Permit Ni m er �
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20195 HOT,YnkL r�A�G;VIITi
Received By
I AKEVILLG MN SSlki4 ��;" � ' "�,`
. y5?-9Rs 443f1 �Date Receivcd
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Submit to pP rnits,i,IakevfAer��r�.go_v � �E,�{,,,t F'ee . �
b�1TE ��'�`t'�Z�Z�� YOUR L-MAIL ADDRESS���� � � ��CG C' " , �
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1'ENANT_.... _..__ SUfTH.NO.
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TH�APPLICAh"1'1S: ❑K�SIlltN`I�O1�1'NER �CONTRACTUR
NAMr s---'1 l.V''� V" C S�'Y\C i`"
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RESIDENT OWNER �n�RF,SS_ �'��,� ���� _c,�� W
C1TY_�—C�4.��'.��� __ _ STAT�, .M_�_- -- Z(P_ ��0�� —��—
DAYTIME PEiQNL kl WHERE YOU CAN B�R�ACH�D �J�Z' � 7 ' tY7C t(/�
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COMPANY N.AM� ���.� �I���i�
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BONU t/: � � �3� � _ _.___. CXPIRAI'ICIN DAI'�
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CUNTRACTOR ADllItESS � 1�� �C"{''��)j/1'� �Q,
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CumpnnV Name must tac as .
listed n�Sta�e Bc�ne! �IT�' .��l� ���, STATE�/�,� Z1P_j���t�L
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OFPICE PI��ONE ii � Z��� �1�� _ _f°AX#
C'nNTACTNAA7[,�� ">i1'�.('{,SS`�t�1 PHON�� �'�j_7�
COMh1ERCIAL C)NLY RESIDF.NTIA1. ONLY
❑NEW HV.�IC'SY'STFh•1 ❑ I7RNAC'E ❑VF.NTI1.ATinN
❑AIR Cf�NDTTION�R �URNACE!�IR C'OM) ❑MISC
❑REFRIGLRAT'IUN �AIR CONll ❑ADllN!REPAIR/RL.PLC
❑GAS PIPING ❑GARAGL HGATFR ❑W PLOOR WATER HEAT
PERMIT TYPE ❑VENTILAT'ION ❑FIREPLACE ❑BOILER REPLC
❑FIREPLACE ❑CiAS NIPING
❑AnDN�RBPAIR/Ri:PI_f'
❑IN FLOOR WATTR IT�AT
❑MISC' Residentiul Permits Availnb�e nn-line
❑NF,W ❑ADnfi'lON ❑ALTF.R!RI?M�n�l.
7'YPF,OF N'ORK
❑REPAIR �tEPLACE ❑DEMOLI'T70N
JOB DESCRIPTION:_ T L� (�',� � �L �� ���
SYSTEAI MAKE: (�'I�y'C'{� j: SYSTFM S['l,E:�pt�K '�Pi� � •�1 � A�'
RESIDFVTIAI. FEES: �40.00 + State Surch�rge($I.00)
COMM17ERCIAL F S:
JOB Ct�ST: $ �t;'O(�}, �,�j Esample; �12,000 Job C�st
I-I/2%of contract cost up to S I 0,000 $]0,000.00 x 1.5`�0= 9;I 50.�0
1°/p of cost abovc S i U,000 Pius surcharge + $ 2,000.00 x 1% _ + 20.U0
(Surcl�arge =Coutract Cost x.00�5) + $12,U00 x.UU05 = + 6.OU
TU7'AL =$0.00 – 176.00
111inimum of$40.00+State Surcharge($1.00) �
1 hercby appty for a mechanical pcnvit and I acknowledgc that ffie infonnation abovc is complete and accuratr, ihat thc work will bc in
confarmance with the ordinanezs and codes of the City of I,akevilie and witli U�e MinnesoW Mechanical Codes:that t underswnd this is nc�t a
pennrt but only un application for a pcnnit and Nurk is not to start without a pennit;that the work will be in accordance with the approved plan in
the case of all work which reyuires revic�r and approval oi'Pluns_
NAME UF APPLICANT(1'lease Print): J'�9 ��SrLt.4�S.S� 1 Date: ���a�'Z-�-''l
SIGNATURE UF Al'PL1CAi�`T: `
PLEASI?NC)'I'E: 5I':P.IRATF:PERMITS ARIi RG UIftTiD FOR ANY BL!ILDItrG,i'LltMF31K(i&GI.6('TRICAi..lti`ORK