HomeMy WebLinkAboutLA177791 PERMIT
City of Lakeville Permit Type: Electrical
20195 xolyoke Ave Permit Number: LA177791
Lakeville,MN 55044 �
(952)985-4440 * L Fl 1 7 7 7 9 1 *
www.ci.lakeville.mn.us Date Issued• 03/04/2020
Site Address: 17448 Glacier Way
Lot: Block: Addition:
PID: �
Use: Springs of Lakeville * *
Description:
Sub Type: CommerciaUIndustrial
Work Type: New
Description: Building#5
Comments:
Fee Summary: Description Amount Revenue Code
EL-Commercial Addn/Rmdl $1,630.00 1000-4167
Valuation: 158,000.00 Surcharge-Based on Valuation $79.00 1000-2127
Total: $1,709.00
Contractor: - Appli��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 ly,
ELECTRICAL PERMIT APPLICATION
;a ermit Number
CITY OF LAKEVILLE ��V
BUILDING INSPECTIONS DEPART'MENT �eived B
� � 20195 HOLYOKE AVENUE Y
LAKEVILLE,MN 55044 �� "'�"`���
952-985-4440 � Date Received
www.lakevillemn.�ov 0.00� � � �j '� ��
Fee Total
DATE �`3' ` ���� YOUR E-MAIL ADDRESS tj@burnsvilleelectric.com
SITE�D�SS 17448 Glacier Wav
'T'ENANT Continental Properties SLTITE NO. BUildlttq 5
TF�APPLIANT I5: �RESIDENT OWNER mCONTRACTOR
NAME Continental 484 Fund LLC
RESIDENT OWNER �D�SS W134 N8675 Executive Parkwav
CI'rY Menomonee Falis STaTE WI ziP 53051
DAYTTME PHONE#WIIERE YOU CAN BE REACHED
COMPANY NAME eumsviile Electric LICENSE#EA 000342
CONTRACTOR ADDRESS 14340 County Rd 5
Company name must be as CITY Bumsville STAT'E MN Zip 55360
appears on State License OFFICE PHONE# FAX#
CONTACT NAME Tj Jakubic PHONE 952 435 9D82
❑SINGLE FAMILY �MIJLTI-FAMILY ❑SWIMMING POOL
❑TWO FAMILY ❑COMMERCIAL/INDUSTRIAL ❑iINDEFINED
PF,RMIT TYPE
❑TOWNHOUSE ❑MANIJFACTURED HOME �FIRE ALARM POWER
❑Meter Bank (Contractor Only) �SIGN
❑Single Meter ❑TNSTTTUTTONAL �OTHER(see description)
Residential Addition/Remodel Permits Available on-line
TYPE OF WORK �NEW �ADDI1'iON �ALTER/REMODEL
❑Mt1INTENANCE(REPAIR ❑TENANT FINiSH QDEMOLITION
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 cau do work in Manufactured Home Parks.
11ETAII Ffl t�FSCRIPTICIN C)F WC)RK• Ruilrling tt5 fnr anartmant�n�pjpV
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�l��'IE'RCI[�T.F�'�'S: Miuimum of$40.00+$1.00 State Sorcharge(one trip}—Remodel Minimum$70.00+$1.00 State Surcharge(two trips)
JOB COST: $ 158,000.00 Egample:$12,000 Job Cost
1-1/2°/a of contract cost up to$10,000 $150.00 $10,000.00 x 1.5%= $150.00
1%of eost above$10,000 plus surcharge + $'�,4$0.00 $ 2,000.00 x 1% _ + 20.00
(Surcharge=Contract Cost x.0005) + $7g.00 $12,000 x.0005 = + 6.00
TOTAL = $1,709.00 = $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 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[JRE OF APPLICANT:
PLEASL NUTE:_SEPARATE PERMTI'S ARE REQUIRED FOR ANY BUILDING,MECHANICAL&PLIJMSING WORK