HomeMy WebLinkAboutLA188772 -Permit Apps 19763 Idealic AveRESIDENTIAL BUILDING
PERMIT APPLICATION
CITY OF LAKEVILLE
BUILDING INSPECTIONS DEPARTMENT
20195 HOLYOKE AVENUE
LAKEVILLE, MN 55044
952-985-4440
Office Use Only
__________________
Permit Number
___________________
Received By
___________________
Date Received
___________________
Fee Total
SITE ADDRESS:
MAILING ADDRESS: CITY: STATE: ZIP:
JOB DESCRIPTION:__________________________________ MASTER PLAN: (Number or Address)____________________
LIST OTHER STRUCTURES ON PROPERTY:_______________________________________________________________
ESTIMATED VALUATION: PROPOSED START DATE: END DATE:
(New Residential Only): LEGAL DESCRIPTION: LOT: _____ BLOCK: _____ SUBDIVISION:
APPLICANT IS: RESIDENT OWNER CONTRACTOR EMAIL
NEW MODEL HOME: YES NO (IF YES – ADMINISTRATIVE PERMIT REQUIRED)
PLEASE FILL OUT THE FOLLOWING COMPLETELY (All Contractor information must be as listed on State License)
RESIDENT OWNER
NAME:_______________________________________________________________________________
HOME PHONE #:_____________________________ CELL PHONE:___________________________
GENERAL CONTRACTOR
Homeowner
Contractor
CONTRACTOR:_______________________________________________________________________
LICENSE #:BC______________ LEAD CERTIFICATE#_______________ (PRE 1978 STRUCTURE)
OFFICE PHONE #:_____________________________ CELL PHONE:___________________________
ADDRESS:____________________________ CITY:________________ ST:______ ZIP:____________
PLUMBING WORK
Homeowner
Contractor
CONTRACTOR:__________________________________________LICENSE #: PM______________
OFFICE PHONE #:_____________________________ CELL PHONE:___________________________
ADDRESS:____________________________ CITY:________________ ST:______ ZIP:____________
MECHANICAL WORK
Homeowner
Contractor
CONTRACTOR:________________________________________ _______________________________
OFFICE PHONE #:_____________________________ CELL PHONE:___________________________
ADDRESS:____________________________ CITY:________________ ST:______ ZIP:____________
BOND #:_______________________________________ EXPIRATION DATE____________________
SEWER/WATER CONTRACTOR
New Construction Only
NAME:________________________________________________ ______________________________
HOME PHONE _____________________________ CELL PHONE:______________________________
BOND #:_______________________________________ EXPIRATION DATE____________________
INTEREST EARNINGS ON THE ESCROW ACCOUNTS, IF ANY, ARE RETAINED BY THE CITY TO OFFSET THE
ADMINISTRATIVE COSTS ASSOCIATED WITH PROCESSING THE ESCROW APPLICATION AND REFUND. I HEREBY
APPLY FOR A BUILDING 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 AND
WITH THE STATE BUILDING CODE, THAT I UNDERSTAND THIS IS NOT A PERMIT AND WORK IS NOT TO START
WITHOUT A PERMIT AND THAT THE WORK WILL BE IN ACCORDANCE WITH THE APPROVED PLAN.
NAME OF APPLICANT (Please Print)DATE
APPLICANT’S SIGNATURE:
www.lakevillemn.gov
Savage
X
19763 Idealic Ave
434-806-4260
55044
permits@everlightsolar.com
MN
434-806-4260
DONNELLY FARM 4TH ADDITION5
7369 Highway 13 W 55378
Shawn Vaughan
Lakeville
BC771658
X
Everlight Solar Construction
1
Rooftop PV Solar Sytem
X
MN
RESIDENTIAL BUILDING PERMIT APPLICATION
PAGE 2
OFFICE USE ONLY
BUILDING PERMIT TYPE REQUIRED INSPECTIONS
SINGLE FAMILY DWELLING BUILDING
DUPLEX AS BUILT
TOWNHOUSE UNITS BUILDING FINAL
DETACHED TOWN HOUSE UNIT DECK FOOTING
CONDO FIREPLACE
ACESSORY BUILDING FOOTING
REROOF FOUNDATION
RESIDE FRAMING
PORCH FRAMING
GARAGES
INSULATION
RES ADDN/REPAIR/RMDL
DECK
PORCH
GARAGES LATH
LOWER LEVEL FINISH LOWER LEVEL FINAL
ADDITION OTHER
FOUNDATION ONLY PORCH FOOTING
MISCELLANEOUS POURED WALL
DEMO SEPTIC TANK REMOVAL
MOVED SITE
MECHANICAL
CITY BUILDING VALUATION: $AIR TEST
FINAL
BUILDING PERMIT FEES ROUGH-IN
$PERMIT FEE PLUMBING
$PLAN CHECK FINAL
$SURCHARGE ROUGH-IN
$METRO SAC METER SIZE
$CITY WATER HOOKUP UNIT PRESSURE REDUCING VALVE
$CITY SEWER HOOKUP UNIT SEWER/WATER
$LANDSCAPE ESCROW SEWER/WATER
$TREE ESCROW FINAL
$MISC ESCROW STREET DRAINTILE
$PLUMBING BUILDING INFORMATION
$MECHANICAL TYPE OF CONSTRUCTION
$SEWER WATER ZONING
$OTHER CODE EDITION
$TOTAL FIRE SUPPRESSION SYSTEM
OCCUPANCY GROUP
APPROVED BY:
BUILDING INSPECTOR: Date:
PLUMBING/MECHANICAL
INSPECTOR: Date:
COMMENTS:
ELECTRICAL PERMIT APPLICATION
CITY OF LAKEVILLE
BUILDING INSPECTIONS DEPARTMENT
20195 HOLYOKE AVENUE
LAKEVILLE, MN 55044
952-985-4440
Office Use Only
___________________
Permit Number
___________________
Received By
___________________
Date Received
___________________
Fee Total
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS
TENANT SUITE NO.
THE APPLIANT IS: RESIDENT OWNER CONTRACTOR
RESIDENT OWNER
NAME_________________________________________________________________________
ADDRESS______________________________________________________________________
CITY _____________________________ STATE_____________ ZIP _____________________
DAYTIME PHONE # WHERE YOU CAN BE REACHED ______________________________
CONTRACTOR
Company name must be as
appears on State License
COMPANY NAME_______________________________________LICENSE #EA___________
ADDRESS_____________________________________________________________________
CITY _____________________________ STATE_____________ ZIP _____________________
OFFICE PHONE # ________________________ FAX #_______________________________
CONTACT NAME______________________________________ PHONE__________________
PERMIT TYPE
SINGLE FAMILY
TWO FAMILY
TOWNHOUSE
Meter Bank
Single Meter
MULTI-FAMILY
COMMERCIAL / INDUSTRIAL
MANUFACTURED HOME
(Contractor Only)
INSTITUTIONAL
SWIMMING POOL
UNDEFINED
FIRE ALARM POWER
SIGN
OTHER (see description)
Residential Addition/ Remodel Permits Available on-line
TYPE OF WORK NEW
MAINTENANCE/REPAIR
ADDITION
TENANT FINISH
ALTER / REMODEL
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.
RESIDENTIAL FEES:
New Construction: $135.00 + $1.00 State Surcharge (up to three trips)
Repairs: + $1.00 State Surcharge (one trip)
Additions, Remodel, Lower Level: $70.00 + $1.00 State Surcharge (two trips)
COMMERCIAL FEES: Minimum of + $1.00 State Surcharge (one trip)---Remodel Minimum $70.00+$1.00 State Surcharge (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 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)
SIGNATURE OF APPLICANT:
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR ANY BUILDING, MECHANICAL & PLUMBING WORK
www.lakevillemn.gov
$40.00
$40.00
7369 Highway 13 W
434-806-4260
MN
Shawn Vaughan
X
X
434-806-4260
55378
55044
EA772271
permits@everlightsolar.com
19763 Idealic Ave
19763 Idealic Ave
X
Everlight Solar Construction
Lakeville
Installation of roof top PV solar system: SYSTEM SIZE: 12.21 kW DC / (37) Silfab SIL-330 NL PV
MODULES / (19) AP Systems YC600 INVERTERS
X
MN
Savage
FOR OFFICE USE ONLY:
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:
AMPERAGE SIZE
SERVICE ENTRANCE CONDUCTOR SIZE
THREE PHASE SINGLE PHASE
DATE UTILITY CONNECTION IS REQUESTED
Lakeville Utility Providers:
Dakota Electric
Xcel Energy
ELECTRICAL AFFIDAVIT
Authorized Signature:
Permit #: LAO
Owner:
Electrical Contractor/Company Name:
Contractor License # CA Master Electrician License #:
Contact Phone #:Office Phone #
Printed Name of Authorized Individual:
THIS CERTIFICATE MUST BE FILLED OUT COMPLETELY BY THE ELECTRICAL
CONTRACTOR AND FILED WITH THE ELECTRICAL UTILITY BEFORE ELECTRICAL SERVICE
CAN BE CONNECTED
Job Site Address:
Mailing Address (Contractor, Company or Owner Performing Installation):
Street Address
City State Zip Code
2/28/2006
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