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PERMIT
City Of LakeVille Permit Type: Electrical
20195 Holyoke Ave Permit Number: LA109118
Lakeville,MN 55044
(952)985-4440 * L R 1 QJ 9 1 1 8 *
www.ci.lakeville.mn.us Date Issued: 12/OS/2008
Site Address: 8755 Upper 208th St W
Lot: 000 Block: 078 Addition: Section 29 Twn 114 Range 20
PID: 22-02900-051-78
Use: Comm Ed Bldg/see Nancy * Z z — � Z q � � — (� 5 1 — 7 8 *
Description:
Sub Type: CommerciaUIndustrial Addn/Rmdl
Work Type: Alter/Remodel
Description: Wire Power Pole
Comments:
Fee Summary: Description Amount Revenue Code
Electrical Commercial (Minimum) $39.50 1000-4167
Surcharge(.50) $0.50 1000-2127
Total: $40.00
Contractor: - Appl;�ant - Owner:
Helm Electric Holyoke Professional LLC
21596 Vernon Avenue 6440 Flying Cloud Dr Ste 203
Lakeville MN 55044 Eden Prairie MN 55344
(952)461-2460
I HEREBY AGREE THAT THIS WORK WILL BE PERFORMED ACCORDING TO: (1)THE APPROVED PLANS&
SPECIFICATIONS; (2)THE APPLICABLE CITY ORDINANCES&CODES;AND(3)THE MN STATE BUILDING CODE.
Applicant/Permitee: Signature Issued By: Signature
� Z � }
ELECTRICAL PERMiT APPLICATION �5��_
CTTY OF LAKEVII,LE Pern►it Number
BUILDING INSPECTIONS DEPAR'TMENT
_ 20195 HOLYOKE A VENLTE � %'-I�'e=�erv�d�y�1 :,: ; ; � ';
LAKEVILLE,MN 55044 � '
952-985-4440 Da;]R�eceived
www.cilakeville.mn.us '�
_�—_.__.
DAT'E 12/4/08 YOUR E-MAII,ADDRESS helmdaue�a integraoniine.com
STTE ADDRESS 8755 UPPER 208 TH ST
TENANT COMM EU BLDG SUTtE NO.
THE APPLIANT IS: ❑RESIDENT OWNER �CONTRACTOR ❑ARCHITECT/ENGINEER
NAME
RESIDENT OWNER �DRESS
CTTY STATE ZII'
DAYTIME PHONE#WHERE YOU CAN BE REACHED
COMPANY NAME HELM ELECTRIC INC LICENSE#CA00832
ADDRESS 21596 VERIdON AVE
CONTRACTOR CITY LAKEVIL.LE STATE MN ZIP 55044
OFFICE PHONE#952 461 2460 FAJ�#952 461 3057
CONTACT NAME DAVE OR RICK MARTINSON PHONE 612 599 9804
❑SINGLE FA14ffLY ❑MUI,TI-FAMILX ❑S WINIlVID�TG POOL
❑TWO FAMII,Y ❑COMMERCIAI.IINDUSTRIAL �UNDEFINED
PERNIIT TYPE �TOWNEIOUSE ❑MANUFACTURED HOME ❑SPRINKLER/ALARM
❑Meter Bank ❑(Contractor Only) ❑STGN
❑Single Meter ❑INSTIT[JTIONAL
TYPE OF WORK ��W ❑��1TION �ALTER/REMODEL
❑MAINT'ENANCE/REPAIR ❑TENANF FINISH ❑DEMOLITION
Only Licensed Electric$I Contractors can do work in a Townhouse that has meter bank instead of�ingle meters attached to the units.
DETAILED DESCRIPTION OF WORK:INSTALL NEW POWER POLE
SEE NANCY
RESIDENTL4L FEES:
New Construotion$85.00(84.50+.50 surcharge) Repairs or Remodel$40.00(39.SQ+.50 surcharge)
COMMERICAL FEES:
JOB COST: �69S.OQ
Example: $12,000 Job Cost
1-1/2%of contract cost up to$1�,000 and $10,000.00 x 1.5% _ $150.00
i°1e of cost above$1d,000 plus surcharge. + $ 2,OOO.QO x 1% - 20.00
(Surcharge=Conuact Cost x.0005} + $12,000 x.0405 - 6.00
TOTAL = 40.00 TOTAL = $17b.OQ
Minimum of 540.(Id(39.50+,50 stucharge)
I hereb�apply for an electricat petmit and I acknowledge that the information above is complete and accurate;that the work will be in
conforn�ance with the ordinances and codes of the City of Lakeville and with the Minnesota Building Codes;that I understand this is not
a permit but only an application for a perniit and work is not to start without a permit;that the work will be in accordance with the
approved ptan in the case of all work which requires review aud appmvai of plans.
NAME OF APPLICANT(Please Print)DAVE 'FINS N Date 12/4/08
SIGNATURE OF APPLICANT:
PLEASE NOTE:SEPr1RATE PERMITS ARE REt21JIRED FOR A1VY BUILDING,MECHANICAL&PLi7MBTNG WOI2K
FOR 4FFICE USE 41�LY:
TYPE OF WORK INSPECTIONS
NEW FIRE ACCEPTANCE
ADDITION TEST
ALTER/REMODEL ROUGH-IN
SERVICfi
TRENCH
FINAL
PERMIT FEE
PERMIT FEE; $
SURCHARGE: $
OTHER: $
TOTAL: $
PERMIT ISSUED BY: ��' � DATE: l�-f �' "�'
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COMMENTS:
(oilo1r�007)