HomeMy WebLinkAboutLA176621 PERMIT
City of Lakeville Permit Type: Electrical
20195 Holyoke Ave Permit Number: LA176621
Lakeville,MN 55044
(952)985-4440 * L R 1 7 6 6 Z 1 �K
www.ci.lakeville.mn.us Date Issued• O1/10/2020
Site Address: 17404 Glacier Way
Lot: Block: Addition:
PID:
Use: Bldg 1
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Description:
Sub Type: Temporary Service
Work Type: New
Description:
Comments:
Fee Summary: Descri tion Amount Revenue Code
Electrical Addition/Remodel Fees $40.00 1000-4167
Surcharge- $1.00 $1.00 1000.2127
Total: $41.00
Contractor: - Appii�a,,t - Owner:
Burnsville Electric
14340 County Road 5
Burnsville MN 55306
(612)363-0407
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.
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Applicant/Permitee: Signature Issued By: Signature
, dffice Use Only
ELECTRICAL PERMIT APPLICATION " �d
Pen t um er
CITY OF LAKEVILLE � Q
BUILDING INSPECTIONS DEPARTMENT
f � '� 20195 HOLYOKE AVBNIIE ( �cp�ived By
LAKEVILLE,MN 55044 U���i
952-985-4440 Date Received
w�vwlakevillemn.�ov 0.00`�'�') ���
Fee Tota1
DATE 1/9/2020 YOUR E-MAIL ADDRESS tj@burnsvilleelectric.com
SIz'E ADD�SS 17404 Glacier Wav
TENANT ContinentalProperties SUITENO. Bulldlnq 1',
THE APPLIANT I5: �RESIDENT OWNER �CONIRACTOR
NAME Continentai Properties
RESIDENT OWNER �DRESS
CITY STATE ZIP
DAYTIME PHONE#WHERE YOU CAN BE REACHED
COMPANY NAME Burnsville Electric LICENSE#EA 000342
CONTRACTOR ADDRESS 14340 County Rd 5
Company name must be as CITY Bumsville S'Y'p'I'E MN ZIp 55360
appears on State License OFFICE PHONE# FAX#
CONTACT NAME �1 Jakubic PHONE 952 435 9062
❑SINGLEFAMILY ❑ML7LTI-FAMILY ❑5WIMMINGPOOL
❑TWO FAMILY ❑COMMERCIAL/INDUSTRIAL ❑UNDEFINBD
PERMIT TYPE
❑TOWNHOUSE ❑MraNiJFACTURED HOME ❑FIRE ALARM POWER
❑Meter Bank (Contractor Only) �SIGN
❑SingleMeter ❑�STITIJTIONAL mOTHER(seedescription)
Residential Additionl Remodel Permits Available on-line
TYPE OF WORK m�W ❑ADDITION ❑ALTER/REMODEL
❑MAINTENANCE/REPAIR ❑TENANT FINISH �DEMOLIT'ION
Only Licensed Electrical Contractors can do work in a Townhouse that has meter bank instead of single meters attached to the units.
Only Licensed Electrical Contractors can do work in Manutactured Home Parks.
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RESIDENTIAL FEES:
New Construction: $135.00+$1.00 State Surcharge (up to three trips)
Repairs: $40.00+$1.00StateSurcharge (onetrip)
Additions,Remodel,Lower Level: $70.00+$1.00 State Surcharge (two trips)
COMMERC�I.F�'ES: Minimum of$40.00+$1.00 State Surcherge(one trip)—Remodel Minimum$70.00+$1.00 State Surcharge(two trips)
JOB COST: $40 Example:$12,OOfl Job Cost
1-1/2%ofcontract costup to$10,000 $40.00 $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) + $1.00 $12,000 x.0005 = + 6.00
TOTAL = $41.00 = $176.00
I hereby apply for an electrical permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the Ciry of Lakeville and with the Minnesota Electrical Act;that I understand this is not a permit
but only an application for a permit and work is not to start without a permit;that the work will be in accordance with the approved plan in the
case of all work which requires review and approval of plans.
NAME OF APPLICANT(Please Print) TJ Jakubic
SIGNAT[IRE OF APPLICANT:
PLEASE NOTE; SEPARAT'E PERMTFS ARE ItEQi3IRED FOR ANY BUILDll+iG;14�fECHhNICAL&PL[FIYIBIlYG WORK