HomeMy WebLinkAboutLA106673 PERMIT
City of Lakeville Permit Type: Mechanical
20195 Holyoke Ave Permit Number: LA106673
Lakeville, MN 55044
(952) 985-4440 * L R 1 0 6 6 7 3
www.ci.lakeville.mn.us Date Issued: 07/01/2008
Site Address: 16345 Crystal Hills Cir
Lot: 048 Block: 001. Addition: Crystal Hills
PID: 22-18550-480-01
Use: * z 2- 1 8 5 5 0- 4 8 0- 0 1
Description:
Sub Type; Heating/Air Cond
Work Type: Replace
Description:
Comments:
Fee Summary: Description 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 Gary J Honken
6950 West 146th St 16345 Crystal Hills Cir
Suite # 106 Lakeville MN 55044
Apple Valley MN 5 5 1 24-0000
(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 I~ ss
e~ y: Signature
MECHANICAL PERMIT APPLICATION office se only
U
CITY OF LAKEVILLE Permit Number
BUILDING INSPECTIONS DEPARTMENT
• ' 20195 HOLYOKE AVENUE Reeeiyed By
LAY.EVILLE, MN 55044
952-985-4440 Date Received
- www.ci.lakeville.mn.ns
r _ P
DATE '~fT"-L~~ YOUR E-MAIL ADD~REiSS
SITE ADDRESS 1 ~ G7 C Y-U ~ ~l 1 I 1 ~ ~.A r
TENANT SUITE NO.
.THE APPLICANT IS: J RESID?ENT OWNER CONTRACTOR
NAM V' ~-f -T-l~C~lN1 i/1
RESIDENT OWNER ADDRESS ~ (9 ~ ~i~-~-~~ 1) ~~-C 1 r
CITY ~f?
~ i 1 ~P ~ STATE__~__``~_ ZIP j
DAYTIME PHONE # WHERE YOU CAN BE REACHED ~ ~ ~
coMrANY Dan Wohlers Southside Htg. & A/C .LICENSE # ~
ADDRESS. 6950 W. 146' St., #106
CONTRACTOR CITY Apple Valley, MN 55124 !IP
OFFICE PH( (952) 431 "7099
CONTACT NAME ~t i t o P PHONE .`°'Y1C'`i~~~
COMMERCIAL ONLY RESIDENTIAL ONLY
? NEW HVAC SYSTEM ? FURNACE REPLACE ? GAS PIPING
? AIR CONDITIONER `FURNACE/AIR COND ? FIREPLACE
? REFRIGERATION REPLACE ? MISC
? GAS PIPING ? AIR COND NEW G ADDN/REPAIR/REPLC
PERMI'T' TYPE a VENTILATION ? AIR COND REPLACE ? IN FLOOR
' ? FIREPLACE ? GARAGE HEATER WATER HEAT
? ADDN/REPAIR/REPLC ? VENTILATION ? BOILER REPLC
IN FLOOR WATER HEAT
? MISC
Residential Permits flvailable on-line
NEW ? ADDITION ? ALTER /REMODEL
TYPE OF WORK
? REPAIR REPLACE ? DEMOLITION
J013 DESCRIPTION• '
~t-~,~C9-J~t~ (~RC`o ~ ~ ~ ~Y~~ ~
SYSTEM MAKE: ~t"? Y`r1(~ SYSTEM SIZE: ~ C~
I/ kESIDENTIAL FEES: $40.00 ($39.50 + .50 surcharge) ~ ~ ~
COMMERCIAL FEES:
JOB COST: $
Example: $12,000 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 = Confract 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) CC
APPLICANT'S SIGNATURE: Q DATE
L
e
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)