HomeMy WebLinkAboutLA196370 - Lakeville_Electrical_Permit_Application_-_Iversen
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
Submit to: permits@lakevillemn.gov
Bernard Saujon
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: