HomeMy WebLinkAboutLA191700 PERMIT
City of Lakeville Permit Type: Sewer& Water
20195 Holyoke Ave Permit Number: LA191700
Lakeville,MN 55044
(952)985-4440 �K L R 1 9 1 7 0 0 �K
wwwlakevillemn.gov Date Issued: 06/10/2021
Site Address: 5075 161st St W
Lot: Block: Addition:
PID:
Use: Spirit of Brandtjen Farms 24th Addn * *
Description:
Sub Type: Commercial
Work Type: New
Description: Sewer and water for new site
Meter Size Meter Twe Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary' Description Amount Revenue Code
Valuation: 842,053.00 Swcharge-Based on Valuation $446.03 1000-2127
SW-Commercial $8,920.53 1000-4153
Total: $9,366.56
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Contractor: - appiicant - Owner:
Meyer Companies Inc
8601 73rd Ave N
Suite 21
Brooklyn Park MN 55428
(763)515-7428
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.
Please provide a minimum of a 24 hour notice to schedule inspections.BUILDING INSPECTIONS: (952)985-4440,8 am-4:30 pm,M-F
ELECTRICAL INSPECTIONS: Call Brian Grey at(507)381-1791,7-830 am,M-F to schedule appointrnents
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Applicant/Permitee: Signature Issued By: Signature
=�,��� ��,�,t���� �..� - �� �- �1 ���..���-�r-
SEWER AND WATER PERMIT APPLICATION O£fice Use Only
� CITY OF LAKEVILLE �� � '�j�}
BUILDING INSPECTIONS DEPARTMENT Permit Number
# 20195 HOLYOKE AVENUE
LAKEVILLE,MN 55044 Received By
952-985-4440 ��-.1
wwwlakevillemn.gov � �" � �71.�'
Submit to:permitsCa�lakevillemn.qov e
DATE 5/28/2021 YOU�t E-MAIL�DREss JSULLIVAN�PWSMN.
SITE ADDRESS 5075 161 st St
TENANT SPIRIT OF BRANDTJEN FARM 24TH ADD SUITENO.
THE APPLICANT IS: ❑RESIDENT OWNER ✓OCONTRACTOR
NAME ECHELON LAKEVILLE LLC
RESIDENT OWNER �DREss 1051 GREENWOOD SPRINGS BLVD
C�TY GREENWOOD STATE IN ziP 46143
DAYTIME PHONE#WHERE YOU CAN BE REACHED 3178867923
COMpAtvYN.�ME MEYER COPMANIES INC LICENSE# PC689875
BOND#: MN5114859 EXPIRATIONDATE 1/1/2022
CONTRACTOR p,DDREss 8601 73RD AVE N SUITE 201
CompanyNamemustbe CITY BROOKLYN PARK STATE MN ZIP
as listed on State Bond
CONTACTNAME JUSTIN SULLIVAN FAX# 6127896542
DAYTIME PHONE#WHERE YOU CAN BE REACHED 7633069628
TYPE FEE
❑SEWER/WATER CONVERSION $90.00+State Surcharge
❑SEWER CONVERSION $90.00+State Surcharge
❑WATER CONVERSION $90.00+State Surcharge
PERMIT TYPE
❑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(MINIMLJM)
❑ MISC(INCLUDES PRNATE SEWER $40.00+State Surcharge(MINIMUM)
REPAIR/NOT SEPTIC SYSTEM) (INSTALL MANHOLES,ETC.)
FOR: �✓ Residential ❑Commercial ❑Industrial
Is Street Excavation necessary?❑YES❑✓NO
If so,has Escrow or Bond been paid&Street Excavation Pernut applied for?❑YES ❑NO
(Call EnQineerinQ Deparhnent,952-985-4500)
DETAILED DESCRIPTION OF WORK• SITE STORM SANITARY AND WATER(Sanitary$169 289 6
Water$368.393.91. Storm $354369.891
COMMERCIAL FEES:
JOB COST: $ 892,053.40 Example:$12,000 Job Cost
1%of cost plus surcharge + $ 920.54 $12,000.00 x 1% _ + 120.00
(Swcharge=Contract Cost x.0005) + �{(�:G� $12,000 x.0005 = + 6.00
TOTAL = �`j "3(���S-�, = 126.00
Minimum of$40.00+State Surcharge$1.00
I hereby apply for a sewer/water 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 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.
NAME OF APPLICANT(Please Print): Date: 5—2 8—2 0 21
SIGNATURE OF APPLICANT:
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 $ �i�1 �� Jr�F
SURCHARGE $ y�f�o� D�
WATER UNIT $
SEWER UNIT $
METROSAC $
OTHER $
TOTAL $ 0.00 a� b����v
APPROVEDBY: ���-7"�_l�— DATE: � /v �-
COMMENTS: 5�-�-t�� �c� � �`,Pr� �t'`�