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Home My WebLink AboutLA202287 - LA202089 Permit Apps 17433 GoodlandRESIDENTIAL 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 *()6"7 "+&5*,,& ! //'3/0/,"173&- "5"(& 0&1-*32&5&1,*()32/,"1$/- /#&133*."1 //%,".%"3) 5&1,*()3/,"1/.2314$3*/. 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 (;(., ;,720./9 52(754897:*9054 0./<(= $ 489(22(90545-# 52(78=89,3 & ! '1$ 088054 52(7 %!#" =89,38& #! % X % 55+2(4+(9/ (1,;022, 6,73098,;,720./9852(7*53 5),79 904(7 % 55+2(4+(9/ 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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