HomeMy WebLinkAboutLA185017 PERMIT
City of Lakeville Permit Type: Electrical
20195 Holyoke Ave a,,, Permit Number: LA185017
Lakeville MN 55044
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(952)985-4440 * L R 1 8 5 (� 1 7 *
www.ci.lakeville.mn.us Date Issued• 10/19/2020
Site Address: 9569 175th St W
Lot: Block: Addition: Section 5 Twn 114 Range 20
PID: 22-00500-27-020
Use: Christina Huddleston Elementary * 2 2 — 0 f� 5 0 PJ — z 7 — PJ 2 PJ *
Description:
Sub Type: CommerciaUIndustrial Addn/Rmdl
Work Type: Alter/Remodel
Description: Filter installation electrical
Comments:
Fee Summary: Descriotion Amount Revenue Code
EL-Commercial Addn/Rmdl $63.54 1000-4167
Valuation: 4,236.00 Surcharge-Based on Valuation $2.12 1000-2127
Total: $65.66
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Contractor: - Applicant - OWner:
Cedar Lake Electric Inc Independent School Dist 194
20700 Bagley Ave 8670 210th St W
Faribault MN 55021 Lakeville MN 55044
(507)334-9546
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
OHice Usc Only
ELECTRICAL PERMI'T APPLICATION 185017
Permit Number
C1TY Oi=LAKEVILLE ML - Email
BUILDING INSPECTIONS DEPARTMENT Received B
/ ' ' 20195 HOLYOKE AVENUE 10/14/�0
LAICEVILLE,MN 55044
952-985-4440 Date Received
...,...•-".-�•"-"' www.lukevillemn.sov
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� Fee T'ota�—
DATE 10/14/2020 YOUR E-MAIL ADDRESS coVb(a�cedariakeelectric.com
sTTE A�DREss 9569 175th Street West
TENANT ISD 194-Christina Huddleston Elem. SUITE NO.
THE APPL[ANT IS: ❑RESIDENT OWNER mCONTRACTOR
NAME INDEPENDANT SCHOOL DISTRICT 194
RCSIDENT OWNER ADDRESS 17630 JUNIPER PATH, SUITE A
Cll'Y LAKEVILLE STATE MN Z1P 55044
DAY"TIME PHONE#WHERE YOU CA�v BE[tEACxED 952-232-20443
COMPANY NAME CEDAR LAKE ELECTRIC LICENSE#EA 000362
CONTRACTOR ADDRESS 20700 BAGLEY AVENUE
Company name must be as CITY FARIBAULT STATE MN ZIP 55021
appears on State License OFFICE PHONE# 507-334-9546 FAX# 507-334-5402
CONTACTNAME COY BORGSTROM PHONe 507-251-1199
❑SINGLEFAMILY ❑MULTI-FAMILY ❑SWIMMWGPOOL
❑TWOFAMILY ❑COMMERCIAL/INDUSTRIAL ❑UNDEFINED
PERMIT TYPE
❑TOWNHOUSE ❑MANUFACTURED HOME �FIRE ALARM POWER
❑Meter Bank (Contractor Only) �SIGN
❑Single Meter m INSTITUTIONAL �OTHER(sec description)
Residenlin!A�lditraii Remode!Permils�varfnble az-line
TYPG O�WORK mNEW ❑ADD[TION ❑ALTER/REMODEL
❑MAINTENANCE/REPAIR ❑TENANT FfNISH ❑DEMOLI?lON
Only Licenscd Clectrical Contractors can do work in a To�rnhouse that has meter bnnk insteAd of singie meters attached to the units.
Only Licensed Electrical Contractors can do«•ork in A7anufactured Ilome Parl:�.
f1FTAll Ffl C]FS(:RIPT�j21V [lF�n�n$K• PC� 1�Fi�7fl Filtar Inctallatinn Flg�,tir��
RESIDENTIAL FEES:
Ne�v Conshuction: S 135.00+$1.00 State Surci�arge (up to three trips)
Repairs: �40.00+$1.00 Stnte Surcharge (one trip)
Additions,Remodel,Lower Level: 570.00+$�,00 State Surchazge (two trips)
C��'��'1ERCTAI�..FC'C'$: ��linimum of$40.00+��,00 Slnte Surcharge(onr trip)--Remodel Diinimum 570.00+$�,p0 Stntc Surc6arge(h��o trips)
JOB CO3T: $4,236.00 Example:$12,000 Job Cost
1-1/2%of contract cc�st up to$10,000 $63.54 �10,000.00 x I.5%= �I50.00
1%of wst above$10,000 plus surcharge + $ 2,000.00 x I% _ + 20.00
(Surcharge=Contract Cost x.0005) + $2.12 $12,000 x.0005 = + 6.00
TOTA� _ $65.66 = 5t76.0o
i hen:by apply for ai� eleceicat pemiit and I acknowledge that the ini'onnation above is complete and accurate; that the work will be in
confonnance with lhe orclinances and codes of the City of Lakeville and with the Minnesota F.lectncal Act;that[understand tl�is is not a pertnil
but only an application for a permit and work is nnt lo starl without a pertnit;that the work will be in accordance with lhe approved pla��iu the
case of all work wLich requires review and approva!of plans.
NAME OF APPLICANT(Please Print) COY O TROM
SIGNATURE OF APPLICAI�T: �:
PLEASE N07'E: SEYARA7'E YEIiM1I S ARE QUIRGD i'OR A\]'BUILDING,IVI�C}IANICAL&PLUMBING WORK