HomeMy WebLinkAboutLA178587 PERMIT
City of Lakeville Pe�it TyPe: Electrical
20195 Holyoke Ave Permit Number: LA178587
Lakeville,MN 55044
(952)985-4440
* L R 1 7 8 5 8 7 *
www.ci.lakeville.mn.us Date Issued: 04/07/2020
Site Address: 18501 Hamburg Ave
Lot: Block: Addition:
PID: �
Use:
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Description:
Sub Type: CommerciaUIndustrial Addn/Rmdl
Work Type: Alter/Remodel
Description: Install new service on PRV pit
Comments:
Fee Summary' Descri tion Amount Revenue Code
No Charge $0.00
Total: $0.00
Contractor: - appti�ant - Owner:
L Allier ElecMc
20269 Lillehei Ave
Hastings MN 55033
(651)325-1404
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
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Office Use Qnl
ELECTRICAL PE IT APPLICATION — - '". (. �,Y
Pe it Num er
CITY OF LAKEVILLE ����
BUILDING INSPECTIONS DEPARTMENT Received B
' ' 20195 HOLYOKE AVENUE �`_, � Y��
LAKEVILLE,MN 55044 1f�
952-985-4440 Date Received
www.lakevillemn.gov �'� ���� �
� � Fee Total
DATE � ^ � YOUR E-MAIL ADDRESS <?`C ���/ cs
SITE ADD�SS t4�Uv�_l �-e ff P� � �' 7��'�n ` Q?�U� "�'C�,� ��L� � '�(�, ,
TENANT SUITE NO.
THE APPLIANT IS: RESIDENT OWNER CONTRACTOR
NAME
RESIDENT OWNER ADDRESS
CITY STATE ZIP
DAYTIME PHONE#WHERE YOU CAN BE REACHED
COMPANY NAME �-.; �C�t''G��.�--� ��/�•(i- LICENSE#EA��,r�Y�
CONTRACTOR ADDRESS ��,�()� �,' (�lZ Z l ('it (�2�-
Company name must be as CITY � '1 " STATE �/�. ✓L ZIP �j Q 3�_
appears on State License OFFICE PHONE# �'�S � l G l7 FAX#
CONTACT NAME �(> �C�.- PHONE_�I�' ?��— !�7 j
SINGLE FAMILY MULTI-FAMILY SWIMMING POOL
TWO FAMILY COMMERCIAL/INDUSTRIAL UNDEFINED
PERMIT TYPE
TOWNHOUSE MANUFACTURED HOME FIRE ALARM POWER
��B� (Contractor Only) SIGN
Single Meter INSTITUTIONAL OTHER(see description)
Residential Addition/Remodel Permits Available on-line
NE ADDITION ALTER/REMODEL
TYPE OF WORK
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 Contractors can do work in Manufactured Home Parks.
DETAILED D�SCRIPTION OF WORK: �� �`! � f r j„ ' �
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RESIDENTIAL FEES:
New Construc6on: $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��'IMERCIAL FEES: Minimum of$40.00+$1.00 State Surcharge(one trip}—Remodel Minimum$70.00+$1.00 State Surc6arge(two trips)
JOB COST: $ Example:$12,000 Job Cost
1-1/2%of contract cost up to$10,000 $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) + $12,000 x.0005 = + 6.00
TOTAL = _ $176.00
I hereby apply for an elech-ical permit and I acknowledge that the information above is complete and accurate; that the work will be in
confo�Ynance with the ordinances and codes of the City of Lakeville and with the Minnesota Electrical Act;that I understand this is not a pernut
but only an application for a pernut and work is not to start without a pernut;that the work will be in accordance with the approved plan in the
case of all work which requires review and appmval of plans.
NAME OF APPLICANT(Please Print) , � ('i- f �
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SIGNATURE OF APPLICANT:
PLEASE NOTE: SEPARATE P REQUIRED FOR ANY BUILDING,MECHANICAL&c PLUMBING WORK
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E�R UF�'�������flN�Y; .:.:,: '.ri.��.n. ..i
TYPE OF WORK INSPECTIONS
NEW FINAL
ADDITION FIRE ACCEPTANCE TEST
ALTER/REMODEL IN FOOR HEAT
ROUGH—IN
SERVICE
TRENCH
PERMIT FEE
PERMIT FEE: $
SURCHARGE: $
OTHER: $
TOTAL: $
PERMIT ISSUED BY: DATE:
COMMENTS:
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