HomeMy WebLinkAboutLA106671 PERMIT
Clay Of LakeV111C Permit Type: Mechanical
201 ~5 Holyoke Ave Permit Number: LA106671
Lakeville, MN 55044
(952) 985-4440 * L R 1 0 6 6 7 1
www.ci.lakeville.mn.us Date Issued: 07/01/2008
Site Address: 16335 Crystal Hills Cir
Lot: 049 Block: 001 Addition: Crystal Hills
PID: 22-18550-490-01
Use: *ZZ- 1855(TJ-49(17-(2J 1*
Description:
Sub Type: Heating/Air Cond
Work Type: Replace
Description:
Comments:
Fee Summary: Descri tion Amount Revenue Code
ME -Residential (Minimum) $39.50 1000-4154
Surcharge(.50) $0.50 1000-2127
Total: $40.00
~ Contractor:. -Applicant - OWner:
Wohlers Southside Htg &A/C Robert E Hoff
6950 West 146th St ]6335 Crystal Hills Cir
Suite # 106 Lakeville MN 55044
Apple Valley MN 55124-0000
(952) 431-7099
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 STATE BUILDING CODE.
Applicant/Permitee: Signature ~ Issued By: Signature
t
MECHANICAL PERMIT APPLICATION ~~ce Use Only
Permit Numb r
CITY OF LAKEVILLE
7 BUILDING INSPECTIONS DEPARTMENT
20195 HOLYOKE AVENUE Reseived~~ ~
LAKEVILLE, MN 55044
952-985-4440 Date Received
www.ci.l akevi 11 e. mn.us
DATE _c_ YOUR E-MAIL ADDRESS ~
SITE ADDRESS I ~ ~~~J ~ u ~~l ~ I ~ ~ ~ -
TENANT SUITE NO.
THE APPLICANT IS: U RESIDENT OWNER CONTRACTOR
NAME
RESIDENT OWNER ADDRESS `~..D~J ~ ~ ~ i ~ G~
CITY (
n1'`~c--c 10 t IP l STATE ZIP
DAYTIME PHONE # WHERE YOU CAN BE REACHEDQ / ~
COMPANY Dan WOl11erS SOUthSlde Htg. & A/C LICENSE #
ADDRESS 6950 W. 146' St., #106
coNTRACTOR CITY Apple Valley, MN 55124 ~1P
OFFICE PHC (952) 431-7099
CONTACT NAME ~"-Ca i t i ~ PHONE :
'II C''nf'~
COMMERCIAL ONLY RESIDENTIAL ONLY
u NEW HVAC SYSTEM a FURNACE REPLACE ? GAS PIPING
? AIR. CONDITIONER FURNACE/AIR COND ? FIREPLACE
u REFRIGERATION REPLACE ~ MISC
GAS PIPING a AIR COND NEW C ADDN/REPAIR/REPLC
PERMIT TYPE ? VENTILATION ? AIR COND REPLACE n IN FLOOR
u FIREPLACE ? GARAGE HEATER WATER HEAT
ADDN/REPAIR/REPLC ? VENTILATION 0 BOILER REPLC
IN FLOOR WATER HEAT
Q MISC
Residential Permits Available on-line
NEW ? ADDITION Q ALTER /REMODEL
TYPE OF WORK ? DEMOLITION
REPAIR QS.tC1;PLACE
e-~--.
JOB DESCRIPTTON:r Qty ~ ~ ^ ^ f
SYSTEM MAKE: ~ 1'`Y"l 1-~ - SYSTEM SIZE: ~ l~Q`C~
'RESIDENTIAL FEES: $40.00 ($39.50 + .50 surcharge) ~t ~ C~
COMMERCIAL FEES:
JOB COST: $ Example: 512,000 Job Cost
1-1 /2% of contract cost. up to $10,000 and $10,000.00 x 1.5% _ $150.00
1% of cost above $10,000 plus surcharge + $ 2,000.00 x 1% = 20.00
(Surcharge =Contract Cost x .0005) + $12,000 x.0005 = 6.00
TOTAL = TOTAL $176.00
Minimum of $40.00 (39.50 + .50 surcharge)~~~'
NAME OF APPLICANT (Please P ' t) h~
APPLICANT'S SIGNATURE: ,-G^ DATE
I~
HEATING PERMIT APPLICATION PAGE 2
OFFICE USE
SYSTEM TYPE: REQUIRED INSPECTIONS:
NEW ROUGH-IN
ADDITION GAS TEST
REPLACE FIREPLACE FRAME
ALTER/REMODEL FIRE/FIRE SMOKE DAMPER EXPANSION
REPAIR FIRE/FIRE SMOKE DAMPER TESTING
DEMOLITION DUCT SMOKE DETECTOR TESTING
FINAL
PERMIT FEE:
HEATING PERMIT FEE: $
SURCHARGE: $
OTHER: $
TOTAL: $
ISSUED BY: DATE:
COMMENTS:
(Revised OS/i8/2006)