HomeMy WebLinkAboutLA176619 PERMIT
City of Lakeville Permit Type: Electrical
20195 Holyoke Ave Permit Number: LA176619
Lakeville,MN 55044
(952)985-4440 �K L R 1 7 6 6 1 9 �K
www.ci.lakeville.mn.us Date Issued• O1/10/2020
Site Address: 17412 Glacier Way
Lot: Block: Addition:
PID:
Use: Bldg 3 * *
Description:
Sub Type: Temporary Service
Work Type: New
Description:
Comments:
Fee Summary' Description Amoun Revenue Code
Electrical Addition/Remodel Fees $40.00 1000-4167
Surcharge- $1.00 $1.00 1000.2127
Total: $41.00
Contractor: - Appl,�a,,t - Owner:
Burnsville Electric
14340 County Road 5
Burnsville MN 55306
(612)363-0407
I HEREBY AGREE THAT THIS WORK WILL BE PERFORMED ACCORDING TO:(1)THE APPROVED PLANS&
SPECIFICATIONS;(2)THE APPLICABLE CITY ORDINANCES&CODES;AND(3)THE MN STATE BUILDING CODE.
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Applicant/Permitee: Signature Issued By: Signature
Office Use Only
ELECTRICAL PERMIT APPLICATION �� C
'ermit Numb r
CITY OF LAKEVILLE I�1'Q_ �
BUILDING INSPECTIONS DEPARTMENT �
j '� 20195 HOLYOKE AVENiJE Received By
LAKEVILLE,MN 55044
952-985-4440 �Receiv,ed
www.lakeviilemn.�ov 0.00�'�l ;�'
Fee Total
DATE 1/9/2020 YOUR E-MAIL ADDRESS tj@bumsvilleelectric.com
SITE aDDREss 17412 Gfacier Wav
T'ENANT Continental Properties SUIT'E NO. BUlldlllq 3✓
Tf�APPLIANT IS: ORESIDENT OWNER �CONTRACTOR
N�$ Continental Properties
RESIDENT OWNER �DRESS
CITY STATE ZIP
DAYT'IME PHONE#WF-IERE YOU CAN BE REACHED
COMPANY NAME eumsville Electric LICENSE#EA 000342
CONTRACTOR ADDRESS 14340 County Rd 5
Company name must be as CIT'I' Bumsville STAT'E MN Zip 55360
appears on State License OFFICE PHONE# FAX#
CONTACT NAME r�akubic pgp�952 435 9062
❑SINGLE PAMILY ❑MULTI-FAMILY ❑SWIMMING POOL
❑TWO FANIILY ❑COMMERCIAL/INDUSTRIAL ❑UNDEFINED
PERMIT TYPE
❑TOWNHOUSE ❑MANUFACTURED HOME �FIRE ALARM POWER
❑Meter Bank (Contractor Only) []SIGN
❑Single Meter ❑INSTTTUTIONAL �JOTHER(see description)
Residential Addition/Remodel Pernzits Available on-line
TYPE OF WORK m�W ❑ADDITION QALTER/REMODEL
❑MAINTENANCE/REPAIR ❑TENANT FINISH �DEMOLITION
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 Cootractors can do work in Manufactured Home Parks.
IIFTAII Fll I�F��RIP71ON nF NnRK• R�iilrling 3 Tam nn rar�$arvir.a
RESIDENTIAL FEES:
New Construction: $135.00+$1.00 State Surcharge (up to three trips)
Repairs: $40.00+$1.00 State Surcharge (one trip)
Additions,Remodel,Lower I,evel: $70.00+$1.00 State Surcharge (two trips)
C��'I�'RC�I.FEES: Minimum of$40.00+$1.00 State Surcharge(one tripp—Remodet Minimum$70.00+$1.00 State Surcharge(two lrips)
JOB COST: $40 Example:$12,000 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 City of I.akeville 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 Jakub'sc
SIGNA"T[JRE OF APPLICANT:
PLEASE NOTE: SEPARATE PERMTJ'S ARE REQUTRED Fl7R ANY BTJILpING;14IECIIANLCAL&PLUMBIlYG WORK