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HEATING PERMIT Permit Fee `j~•
I~ & F3@c@1 pt State Surcharge .50
TOTAL FEE PAID
Permission is hereby granted to ' ` ' t ~ ~ ~ r, ~ 'T~ r
Building on Lot No. ~ Block~~ Subdivision
Parcel ;c~,~...1+f~.,~ +i;t;-t'l2 Plat
In the CITY OF LAKEVILLE to be used as ~ 'r+`~ t ~ r ~ i ';!a * ~ r n n~a ~ ~1 ° t• t° ~c ~ _
This permit is issued on the express condition that the 'F ERECTION -ALTERATION -REPAIRS
----ENLARGEMENT ~AOVING -DEMOLITION respects to the statements certified to in the application for
such permit, and that all work shall be done in accordance with the Ordinance of LAKEVILLE, Minnesota and the State of Minnesota
.pertaining to the construction of buildings.
StreetAddreS3 ~ f'~ g'.C'?'k, ~'_.;T ~'{rtl.'"~ ,y;1,^.. r, I,a-t,^;orc?
Director, License and Inspection
Attention is particularly called to the cutting up of streets, making main sewer
connections, driveways and curbs. Obtain permit for such construction from theClTY
OF LAKEVILLE. Inspection Department Not Responsible For Any Damages to Public By ; taxes` ~ =,,~,i
Utilities.
DAT$ ~ r~~
CITY OF LAKEVILLE
BUILDING INSPECTION DEPARTMENT - (6I2) 469-4431
APPLICATION ..FOR HEATING PERMIT
Site Address : ~LY1,3 ~ ((~~~113') ~i1
Alter Repair
Legal: Lot Block Addition Install Replace
MAKE _,11,x TYPE OF SYSTEM
SIZE Worm Air Plants
CONN. LOAD - Gravity
FUEL
iJ Mechanical
FLUE DIA. l o Air Conditioning
SUPPLY OPENINGS
• Vent System
RETURN OPENINGS Heating or Power Plant
INPUT ~o~;
Steam
OUTPUT ~O Hot Water
EDR Radiation
CFM
Wood-burning Stove:
Wood-burning Fireplac~•
Plan No. Date
Est. Comp. Date Est. Cost. Heating Permit fet
State Surcharge ' J~
Total Permit Fees ~~a
4
Owner's Nome ~ 1 ~ ~ MQYY~.
Address v~d~ ~ '~(~Q~ . o~-
Heating Contracto Tel. ? p,,
Address City l Zip CY
Heating, Air Conditioning, Ventilation Refrigeration Permit Fee for single family residence in-
stollotion ($29.50 + _50 surcharge)
Alteration or RepoirMin. Fee_5~15.50 ~ _50 surcharge)
Non Residential Fee shall be computed at 1 % of the contract up to $10, 000; i% for
balance over $10,000 + :SO surcharge. Minimum=$24.50+.50-___________$
(GAS PIPING INCLUDED)
Send application and heat loss calculation with check for Permits to:
CITY OF LAKEVILLE
Glenn A. (Barney) Langord Inspectian Department Notice:
Plumbing & Heating Inspector Box 957 Call for inspection when
Lakeville, MN 55044 work is completed.