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Home My WebLink AboutLA184272 PERMIT City of Lakeville Permit Type: Sewer& Water 20195 xolyoke Ave Permit Number: LA184272 Lakeville,MN 55044 (952)985-4440 * L R 1 8 4 2 7 2 * www.ci.lakeville.mn.us Date Issued• 10/09/2020 Site Address: D6 Grumman La Lot: Block: Addition: PID: � Use: Jay Jenkins Hangar * * Description: Sub Type: Commercial Work Type: New Description: Meter Size Meter Tvne Manufacturer Serial Number Remote Number Line Size Comments: Fee Summary: Description Amount Revenue Code Surcharge-Based on Valuation $1.20 l 000-2127 Valuation: 2,400.00 SW-Commercial $40.00 ]000-4153 SAC-Commercial/lnstitutional $2,485.00 ]000-2128 Comm Water Unit $2,050.00 5500-4560 Comm Sewer Unit $825.00 5600-4570 Total: $5,401 ZO 1 ' � �. - ( . � �� ., _`�, Contractor: - App�;�a„t - Owner: Perfect Mechanical LLC 9850 Iteri Ct W Lakeville MN 55044 (507)581-1082 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. , ��,,�„ '� ApplicanUPermitee: Signature Issued By: Signature � l�E c� D .t7r+c�/ SEWER AND WATER PERMIT APPLICATION Office se_I y � ` - -__� � < �` ti':!�. CITY OF LAKEVILLE it Number ��`f,��i BUILDING INSPECTIONS DEPARTMENT �-�' �� '��t�ry{�j 20195 HOLYOKE AVENUE R eived By ��' � ''' r� '^�� LAKEVILLE,MN 55044 c� �.. ``�""'_,��;,,,..�" 952-985-4440 � �'" �' ` www.lakevillemn.gov, / Date eceivefl ,�� `. DATE S[o�" �y o�� YOUR E-MAIL ADDRESS R,r�M �3 l:9 I✓�A I'C�V� .%��.�``-- + SITE ADDRESS 'D Q! Ca r'V �iMbtn �-�. i;4' TENANT SU1TE NO. �` THE APPLICANT IS: RESIDENT OWNER CONTRACTOR � � NAME �; RESIDENT OWNER ADDRESS CITY STATE ZIP �% '� DAYTIME PHONE#WHERE YOU CAN BE REACHED � COMPANY NAME�t.f�eck' �GcJ1 c�,�;�,..� (,L.,C. LICENSE# 1�C.7SF�7� �� BOND#: IN1'�7�5 S��J EXPIRATION DATE ��/OTL ' CONTRACTOR ADDRESS ` k'SD /1�+'� �- � � t` Company Name must be �- as listed on State Bond CITZ' Lw Kt.�J�� STATE yV�Jl� ZIP ssC7 y� #�� CONTACT NAME_2� Bt�,Z;h� FAX# DAYTIME PHONE#WHERE YOU CAN BE REACHED SO'7^ S�J" I 08'1 � TYPE FEE �' �y; SEPTIC SYSTEM $250.00+State Surcharge f'' NEW/REPAIR/REPLACE Q` SEWER/WATER CONVERSION $90.00+State Surcharge � SEWER CONVERSION $90.00+State Surcharge � WATER CONVERSION $90.00+State Surcharge �` PERMIT TYPE �w COMMERCIAL Per Commercial Fee Formula Below (INCLUDES WATER/FIRE LINE) $40.00+State Surcharge(MINIMUM) STREET DRAINTILE(TYING INTO CITY LINE) $40.00+State Surcharge(MINIMUM) MISC(INCLUDES PRIVATE SEWER $40.00+State Surcharge(MINIMLIM) f`: REPAIR/NOT SEPTIC SYSTEM) (INSTALL MANHOLES,ETC.) # �`j' FOR: Residential Commerci Industrial Is Street Excavation necessary? YES N,S If so,has Escrow or Bond been paid&Street Excavation Permit applied for? YES NO Call En 'neerin D arttnent 952-985-4500 DETAILED DESCRIPTION OF WORK: COMMERCIAL FEES: JOB COST: $�Y(�� Example:$12,000 Job Cost 1%of cost plus surcharge �y.:�' _ $12,000.00 x 1% _ + 120.00 r (Surcharge=Contract Cost x.0005) f . t,;,�Q x.0005 = + 6.00 TOTAL -- Minimum of$40.00+State Surcharge � • = 126.00 I hereby apply for a sewer/water permit and [ acirnowledge that Uie informapon above is complete and accurate; that the work will be in conformance with the ordinances and codes of the Ciry of Lakeville and witl�the Minnesota Codes;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. NA11'IE 4F APPLICANT(Please Print): /ei�G� ��•�jt� Date: CJ� i�� SIGNATURE OF APPLICAIVT• � M,°;: ..fx�-� , _ SEWER AND WATER PERMIT APPLICATION PAGE 2 ^ - OFFICE USE WORK TYPE INSPECTIONS � NEW BACTERIA TEST ADDITION CONDUCTIVITY TEST REPAIR FINAL DEMOLISH HYDROSTATIC TEST REPLACE HYDRANT FLUSH ALTER/REMODEL // SEWER LINE STREET DRAINTILE STORM SEWER _�WATER LINE OTHER PERMIT FEE: PERMIT FEE $ '�'�� . v� SURCHARGE $ �. �� WATER UNIT $ zp sp ^ SEWER LJNIT $ �L 5 ^ METRO SAC $ `ZY�� OTHER $ TOTAL $ S� ��/ ' � APPROVED BY: �C'~/V�� DATE: I �-7 �� COMMENTS: (Revised 1/14/2020)