HomeMy WebLinkAboutLA176618 PERMIT
City of Lakeville Permit Type: Electrical
20195 Holyoke Ave Permit Number: LA176618
Lakeville,MN 55044
(952)985-4440 * L A 1 7 6 6 1 8 �K
www.ci.lakeville.mn.us Date Issued• O1/10/2020
Site Address: 17448 Glacier Way
Lot: Block: Addition:
PID:
Use: Bldg 5
�K �K
Description:
Sub Type: Temporary Service
Work Type: New
Description:
Comments:
Fee Summary' DescriR ion Amount Revenue Code
Electrical Addition/Remodel Fees $40.00 1000-4167
Surcharge- $1.00 $1.00 1000.2127
Total: $41.00
Contractor: - Appi;�ant - 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.
.�
���,y\ 3�
Applicant/Permitee: Signature Issued y: Signature
Office Use Only
ELECTRICAL PERMIT APPLICATION � � �� C.�j
Permit Number
CITY OF LAKEVILLE ��jb - �/1
BUILDING INSPECTIONS DEPARTMENT ��v
� '' x 20195 HOLYOKE AVENIJE Rece By
LAKEVILLE,MN 55044
952-985-4440 Date eceived �
www.lakevillemn.gov 0.00� +���
Fee Total
DAT'E 1/9/2020 YOUR E-MAIL ADDRESS tj(�bumsvilleelectric.com
SI'rE ADD�sS 17448 Glacier WaV
T'ENANT Continental Properties SU1`rE rro. Buildinq 5�
TI�APPLIANT IS: �RESIDENT OWNER mCONTRACTOR
NAME Continental Properties
RESIDENT OWNER �DRESS
CITY STATE ZIP
DAYTIME PHONE#WHERE YOU CAN BE REACHED
COMPANY Nt�ME Burnsviile Electric LICENSE#EA 000342
CONTRACTOR �DRESS 14340 County Rd 5
Company name must be as CIT'Y Bumsville STATE MN Zip 55360
appears on State License OFFICE PHONE# FAX#
CONTACT NAME Tj Jakubic PHONE 952 435 9062
❑SINGLEFAMILY ❑MULTI-FAMILY ❑SWINIMINGPOOL
❑TWO FANIILY ❑COMMERCIAL/INDUSTRIAL ❑i)NDEFINED
PERMIT TYPE
❑TOWNHOUSE ❑MANiJFACTURED HOME �FIRE ALARM POWER
❑Meter Bank (Contractor Only) �SIGN
❑Single Meter ❑�STTTUTTONAL mOTHER(see description)
Residential Addition/Remodel Permits Available on-line
TYPE OF WORK mNEW ❑ADDITION �AL'TER/REMODEL
❑MAINTENANCE/REPAIR ❑TENANT FINISH �DEMOLITTON
Only Licensed Electrical Contractors can do work in a Townhouse that has meter bank instead of single meters attac6ed to the units.
Only Licensed Electrical Contractors can do work in Manufactured Home Parks.
IIFTAII Ff� nFSCR{PT{(�N (lF WQRK• R�ilriing .r,Tam nn rar�/Sa iira
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 Level: $70.00+$1.00 State Surcharge (two trips)
C�MMERC�I.FEES: Minimum of$40.00+$1.00 State Surcherge(one trip�Remodel Mioimum$70.00+$1.00 State Surcharge(two trips)
JOB COST: $40 Example:$12,000 Job Cost
1-1/2%ofcontractcostupto$10,000 $40.00 $10,000.00x1.5%= $I50.00
1%ofcost above$10,000 plus surcharge + $ 2,000.00 x 1% _ + 20.00
(Surcharge=Contract Cost x.0005) + $1.OQ $12,000 x.0005 = + 6.00
TOTAL = $41.00 = $1'76.00
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 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
SIGNATURE OF APPLICANT:
PLEASE NOTE: 3EFARATE FERMTCS ARE REQiJIRED FOB,ANY BUILDING;MECII�#NICA�.&PLUMBIlYG R'OItK _