HomeMy WebLinkAboutLA178399 PERMIT
City of Lakeville Permit Type: Electrical
20195 Holyoke Ave Permit Number: LA178399
Lakeville,MN 55044
(952)985-4440 * L R 1 7 8 3 9 9 *
www.ci.lakeville.mn.us Date Issued• 03/31/2020
Site Address: 9776 212th St W
Lot: Block: Addition:
PID:
Use: Iton
�K *
Description:
Sub Type: CommerciaUIndustrial Addn/Rmdl
Work Type: Alter/Remodel
Description: 1 circuit pole mounted electrical service for utility
equip
Comments:
Fee Summary: Descri,ption Amount Revenue Code
Valuation: 1,725.00 Electrical Commercial(Minimum) $40.00 1000-4167
Surcharge- $1.00 $1.00 1000.2127
Total: $41.00
Contractor: - Appli��t - Owner:
Midbrod Electric
5627 Memorial Ave N
Stillwater MN 55082
(651)351-5074 X7
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 I sued By: Signature
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, , ce Use Only
ELECTRICAL P RMIT APPLICATION �� ' G
- Permit Number
C1TY OF LAKEVILLE j
BUILDING INSPECTIONS DEPARTMENT ������� � �
Received By
/ j 2Q195 HOLYOKE AVENUE � ,
LAKEVILLE,MN 55044 �� �} � ~ �
952-985-4440 Date Received
www.lakevillemn.�ov 0.00���•��
r Fee Total
DATE �=''��LI � v�C.� YOUR E-MAIL ADDRESS � W��c� b�t~,c��(�'c/rv�C�c ./1�C_;
srrE���ss 91 � t� �1 �-`�`' �4- � � L.A.,� v�l t� m�►�.J
TENANT SUITE NO.
TT�APPLIANT IS: �RESIDENT OWNER '�CON'TRACTOR
NAME �-}p r�
RESIDENT OWNER �DRESS v2 l 1 1 (v csti�--� 1`� � � f`t r �� •
CIT'Y j--t {�e. r.��.e.��-� STATE (;�!/� ZIP (. � � l ��
DAYTIME PHONE#WHERE YOU CAN BE REACHED (v S I-02 �o �- 'Z���j
COMPANY NAME ���c� C� i �d ������ LICENSE#EA C7v 1�3�I
CONTRACTOR ADDRESS S tn�� ►'Y� � m t z� A�'-z
Company name must be as CI7'V 4'�`��W� "� �r� STATE �� ZIP '�'��'� �'
appears on State License OFFICE PFiONE#I��(- 3� �-�L�� FAX# �o �l ^ ���`���-�
CONTACT NAME ��t�-��U ���-rc Y pgp� 1�'S1'�(`t 1 1S��
❑SINGLE FAMILY ❑MULTI-FAMILY ❑SWIIvIlbIING POOL
❑TWO FAMILY ❑COMMERCIAL/1NDUSTRIAL ❑UNDEFINED
PERMIT TYPE
❑TOWNHOUSE ❑MANUFACTURED HOME �FIRE ALARM POWER
❑MeterBank �ContractorOnly) �SIGN
❑Singie Meter ❑�STIT[JTIONAL ��ER(see description)
Residential Addition/Remodel Permits Available on-ltne
NEW QADDITION �ALTER/REMODEL
TYPE OF WORK
❑MAINTENANCEIREPAIR �TENANT FINISH �DEMOLTTION
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 Manufactared Home Parks.
D CRIP F : � C� � r C;��.,�'�" _ c!�-� t'�n e�:.���� � ��C�'�-r �c�
v: -� ll � C'_. �i - mr�
RESIDENTIAL FEES:
New Construcrion: $135.00+$].00 State Surcharge (up to three trips)
Repairs: $40.00+$1.00 Statc Surchargc (onc trip)
Addirions,Remodel,Lower Level: $70.00+$I,00 State Surcharge (two trips)
COMMLPR�t�I.�ES: Minimum of S40.00+51.00 State Snre6arge(one trip)—Remodel Minimum 570.00+$1.00 State Snrcharge(two trips)
JOB COST: $ (��a:t� v Example:$12,000 Job Cost
1-1/2%of contract cost up to$10,000 `'�' C7 ��� $10,000.00 x 1.5%_ $150.00
1%of cost above$10,000 pius surchazge + $ 2,OOp.00 x 1% _ + 20.00
(Surcharge=Contract Cost x.0005) + � .C�C> $12,000 x.0005 = + 6.00
TOTAL = $0.00 � �.C�Q = $176.00
I hereby apply for an electrical permit and 1 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 1 understand this is not a pennit
but only an applicarion for a pernut 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 approvai of plans.
NAME OF APPLICANT(Please Print) �1( �5'� I r\ �� {�;��
SIGNATURE OF APPLICANT:
et.�.���vmC�:s�r�►�i� ;r�t�tt�s�i�a�pu►�r�t�nx�vY;au�t.nirrr,�� -��1.u�a�r�G wonrt%- ,