HomeMy WebLinkAboutLA225521 - Jose Casique Permit ApplicationRESIDENTIAL 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:________________________________________ _______________________________
_____________________________ CELL PHONE:___________________________
ADDRESS:____________________________ CITY:________________ ST:______ ZIP:____________
BOND #:_______________________________________ EXPIRATION DATE____________________
SEWER/WATER CONTRACTOR
New Construction Only
NAME:________________________________________________ ______________________________
_____________________________ CELL PHONE:______________________________
BOND #:_______________________________________ EXPIRATION DATE____________________
NAME OF APPLICANT (Please Print)DATE
Submit Application To: permits@lakevillemn.gov
*
*Entering your name affirms your intent to comply with the statement above.
OFFICE PHONE #:_
OFFICE PHONE #:_
I HEREBY APPLY FOR PERMIT AND ACKNOWLEDGE THAT ALL INFORMATION ON THIS
APPLICATION IS COMPLETE AND ACCURATE. THIS IS NOT A PERMIT AND WORK IS NOT TO
COMMENCE UNTIL SUCH TIME A PERMIT IS ISSUED. ALL WORK WILL COMPLY WITH
LAKEVILLE CITY CODE, THE MINNESOTA STATE BUILDING CODE, AND THE APPROVED
PLANS. INTEREST EARNINGS ON ESCROW ACCOUNTS, IF ANY, WILL BE RETAINED BY THE
CITY TO OFFSET THE ADMINISTRATIVE COSTS ASSOCIATED WITH PROCESSING THE
ESCROW APPLICATION AND REFUND.
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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
CONDO
REROOF
RESIDE
RES ADDN/REPAIR/RMDL
DECK
PORCH
GARAGES
LOWER LEVEL FINISH
ADDITION
FOUNDATION ONLY
MISCELLANEOUS
DEMO
APPROVED BY:
BUILDING INSPECTOR: Date:
PLUMBING/MECHANICAL
INSPECTOR: Date:
COMMENTS:
CITY BUILDING VALUATION: $
BUILDING PERMIT FEES
$PERMIT FEE
$PLAN CHECK
$SURCHARGE
$METRO SAC
$CITY WATER HOOKUP UNIT
$CITY SEWER HOOKUP UNIT
$LANDSCAPE ESCROW
$TREE ESCROW
$MISC ESCROW
$PLUMBING
$MECHANICAL
$SEWER WATER
WATER METER
PRESSURE REDUCING VALVE
$OTHER
$TOTAL
METER SIZE
PRESSURE REDUCING VALVE
SEWER/WATER
SEWER/WATER
FINAL
STREET DRAINTILE
BUILDING INFORMATION
TYPE OF CONSTRUCTION
ZONING
CODE EDITION
FIRE SUPPRESSION SYSTEM
OCCUPANCY GROUP
MECHANICAL
AIR TEST
FINAL
ROUGH-IN
PLUMBING
FINAL
ROUGH-IN
INSULATION
LATH
DECK FOOTING
FIREPLACE
FOOTING
FOUNDATION
FRAMING
PORCH FRAMING
PORCH FOOTING
POURED WALL
SITE
LOWER LEVEL FINAL
OTHER
DECK FRAMING
LOWER LEVEL FRAMING
LANDSCAPING
DECK FINAL
$
$
ACCESSORY BUILDING
EGRESS WINDOW
UNDERGROUND
65%
0.00
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
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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: