MECHANICAL PERMIT APPLICATION - City of Lakeville

MECHANICAL PERMIT APPLICATIONCITY OF LAKEVILLEBUILDING INSPECTIONS DEPARTMENT20195 HOLYOKE AVENUELAKEVILLE, MN 55044952-985-4440www.ci.lakeville.mn.usOffice Use Only___________________Permit Number___________________Received By___________________Date ReceivedDATEYOUR E-MAIL ADDRESSSITE ADDRESSTENANTSUITE NO.THE APPLICANT IS: RESIDENT OWNER CONTRACTORRESIDENT OWNERCONTRACTORPERMIT TYPETYPE OF WORKNAME________________________________________________________________________ADDRESS_____________________________________________________________________CITY _____________________________ STATE_____________ ZIP _____________________DAYTIME PHONE # WHERE YOU CAN BE REACHED ______________________________COMPANY NAME_______________________________________LICENSE #______________ADDRESS_____________________________________________________________________CITY _____________________________ STATE_____________ ZIP _____________________OFFICE PHONE # ________________________ FAX # _______________________________CONTACT NAME______________________________________ PHONE__________________COMMERCIAL ONLYNEW HVAC SYSTEMAIR CONDITIONERREFRIGERATIONGAS PIPINGVENTILATIONFIREPLACEADDN/REPAIR/REPLCIN FLOOR WATER HEATMISCNEWREPAIRRESIDENTIALFURNACE REPLACEFURNACE/AIR CONDREPLACEAIR COND NEWAIR COND REPLACEGARAGE HEATERVENTILATIONResidential PermitsADDITIONREPLACEONLYGAS PIPINGFIREPLACEMISCADDN/REPAIR/REPLCIN FLOORWATER HEATBOILER REPLCAvailable on-lineALTER / REMODELDEMOLITIONJOB DESCRIPTION:SYSTEM MAKE:SYSTEM SIZE:RESIDENTIAL FEES: $40.00 ($39.50 + .50 surcharge)COMMERCIAL FEES:JOB COST: $Example: $12,000 Job Cost1-1/2% of contract cost up to $10,000 and $10,000.00 x 1.5% = $150.001% of cost above $10,000 plus surcharge + $ 2,000.00 x 1% = 20.00(Surcharge = Contract Cost x .0005) + $12,000 x.0005 = 6.00TOTAL = TOTAL $176.00Minimum of $40.00 (39.50 + .50 surcharge)NAME OF APPLICANT (Please Print)APPLICANT’S SIGNATURE:DATE

HEATING PERMIT APPLICATION PAGE 2OFFICE USESYSTEM TYPE:NEW_____ADDITIONREPLACE_____ALTER/REMODELREPAIR_____DEMOLITIONREQUIRED INSPECTIONS:ROUGH-INGAS TESTFIREPLACE FRAMEFIRE/FIRE SMOKE DAMPER EXPANSIONFIRE/FIRE SMOKE DAMPER TESTINGDUCT SMOKE DETECTOR TESTINGFINALPERMIT FEE:HEATING PERMIT FEE: $_______________SURCHARGE:OTHER:TOTAL:$_______________$_______________$_______________ISSUED BY:_____________________________________________________DATE:_______________________COMMENTS:(Revised 05/18/2006)