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PERMIT
Clty of Lakeville Permit Type: Electrical
20195 Holyoke Ave Permit Number: LA105625
Lakeville, MN 55044
(952) 985-4440 * L A 1 fl7 5 6 2 5
www.ci.lakeville.mn.us Date Issued: 05/02/2008
Site Address: 17202 Eastwood Ave
Lot: 001 Block: 003 Addition: Lake Place 4th Addition
PID: 22-44078-185-15
Use:
* Z Z- 4 4 i?J 7 8- 1 8 5- 1 5 ~K
.Description:
Sub Type: Off Peak
Work Type: New
Description: -
Comments:
Fee Summary: Description Amount Revenue Code
EL-Residential Addition/Remodel $39.50 1000-4167
Surcharge (.50) $0.50 1000-2127
Total: $40.00
i Contractor: -Applicant - OWner:
Powerhouse Electric Inc Joshua M Girardin
~ 1958 Raspberry Lane 17202 Eastwood Ave
Shakopee MN 55379 Farmington MN 55024
(952) 233-5404
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.
Applicant/Permitee: Signature Issued By`• Signature
s
ffice Use Only
ELECTRICAL PERMIT APPLICATION ~~J-~-~~
Permit Number
~ ~ ~ CITY OF LAKEVILLE
BUILDING INSPECTIONS DEPARTMENT
~ I 20195 HOLYOKE AVENUE Received By
' LAKEVILLE, MN 55044
~ 952-985-4440 Date Received
www.ei.lakeville.mn.us
Fee Total
DATE ~ YOUR E-MAIL ADD ESS
SITE ADDRE S
TENANT SUITE NO.
THE APPLIANT IS: RESIDENT OWNER ®CONTRACTOR ARCHITECT/ENGINEER
NAME C,1
RESH)ENT OWNER ADDRESS ;
CITY STATE ZIP
DAYTIME PHONE # WHERE YOU CAN BE REACHED r z
COMPANY NAME POWERHOUSE ELECTRIC INC LICENSE # CA03631
ADDRESS 1958 RASPBERRY LANE
CONTRACTOR CITY SHAKOPEE STATE MN ZIP 55379
OFFICE PHONE # 952-233-5404 FAX #
CONTACT NAME PHONE 952-292-4981
NG E FAMILY MULTI-FAMILY SWIMMING POOL
TWO FAMILY COMMERCIAL /INDUSTRIAL UNDEFINED
PERMIT TYPE TOWNHOUSE MANUFACTURED HOME SPRINKLER/ALARM
Meter Bank (Contractor Only)
SIGN
Single Meter INSTITUTIONAL
NFL ADDITION ALTER /REMODEL
TYPE OF WORK ~°1~?LII~I'
AI ENANCE/REPAIR TENANT FINISH DEMOLITION
Only Licensed Electrical Contractors can do work in a Townhouse tiha/t has meter bank instead of single meters attached to the units.
DETAILED DESCRIPTION OF WORK: F"'
RESIDENTIAL FEES:
New Construction $85.00 (84.50 + .50 surcharge) Repairs or Remodel $40.00 (39.50 + .50 surcharge)
COMMERCIAL FEES: ~
JOB COST: $
Example: $12,000 Job Cost
1-1/2% of contract cost up to $10,000 and $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 = TOTAL $176.00
Minimum of $40.00 (39.50 + .50 surcharge)
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 Building Codes; that I
understand this is not a permit but only an application for a pernit 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);
~~~j `r
q~,, , ~y'~~ ~ ~ Date l
SIGNATURE OF APPLICANT: ~ 2~. ~'1~~~ I° 1~~' ~ u'~
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR ANY BUILDING, MECHANICAL & PLUMBING WORK
FOR OFFICE USE ONLY:
TYPE OF WORK INSPECTIONS
NEW . FIRE ACCEPTANCE TEST
ADDITION ROUGH-IN
ALTER/REMODEL SERVICE
TRENCH
FINAL
PERMIT FEE
PERMIT FEE: $
SURCHARGE: $
OTHER: $
TOTAL: $ ~ -
PERMIT ISSUED BY: DATE:
COMMENTS:
(0 110 1 /2007)