HomeMy WebLinkAboutLA108053 ELECTRICAL PERNIIT APPLICATION
f~i~o~'s
' Permit Number
CTTY OF LAKEVILLE
BUILDING INSPECTIONS DEPARTMENT
~ 20195 HOLYOICE AVENUE Received By
LAREVILLE, MN 55044
,l 952-985-4440 Date Received
www.ci.lakeville.mn.us
C~ ~f Fee Total
~ DATE 1 c 'O p YOURE-MAIL ADDRESS
SITE ADDRESS A- ~ ~
TENANT ~2.I~ SUTTE NO.
THE APPLIANT IS: ? RESIDENT OWNER ~'UNTRACTOR ? ARCHITECT/ENGINEER
NAME
RESIDENT OWNER ADDRESS
CITY STATE ZIP
DAYTIME PHONE # WHERE YOU CAN BE REACHED i ~ 2~
COMPANY NAME Q~~ ~.TfL-~e II~C• LICENSE # ~ ~ t y I ~ ~.Y~
ADDRESS ' 1 1 ~ 1 L Tom./ O~"I ~ ~ ~ _ ~ .
CONTRACTOR CITY ')i>~- "Tr~l.~ STATE~ZIP ~z-'lc7-G
OFFICE PHONE # '(„7~ LJl C`~ FAX # ] J~ - ~ J - c~~ 1
CONTACT NAME ~2~~'z PHONE fQfo~-~ ILI
? SINGLE FAMILY ?MULTI-FAMILY ? SWIMMING POOL
? TWO FAMILY ? COMMERCIAL /INDUSTRIAL ? UNDEFINED
PERMIT TYPE OWNHOUSE ? MANUFACTURED HOME ? SPRINKLER/ALARM
(Contractor Only) ? SIGN
? Meter Bank
? Single Meter ? INSTITUTIONAL
? NEW ? ADDITION ? ALTER /REMODEL
TYPE OF WORK
? MAINTENANCE/REPAIR ? TENANT FINISH ? DEMOLITION
Only Licensed Electrical CoutraMors can do work in a Townhouse that has meter bank instead of single meters attached to the units.
DETAILED DESCRIPTION OF WORK:
RESIDENTIAL FEES:
New Construction $85.00 (84.50 + .50 surchazge) Repairs or Remodel $40.00 (39.50 + .50 surchazge
i COMMERCLIL 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 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)T~ Date
SIGNATURE OF APPLICANT: ~ < ;
PLEAtiE NOTE: SF;PARA"1'E PEKMI"1'S ARE LRE'QIiIRED FOR Atil' BUILDING. '11E('HANlC.41, & PLUMING ~i'ORK
PERMIT
Clty Of LakeVllle Permit Type: Electrical
20195 Holyoke Ave Permit Number: LA1080S3
Lakeville, MN 55044
(952) 985-4440 * L A 1 QJ 8 0 S 3
www.ci.lakeville.mn.us Date Issued: 09/17/2008
Site Address: 16367 Etm Creek La
Lot: Block: Addition:
PID:
Use:
Description:
Sub Type: Meter Room
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
Contractor: -Applicant - OWner:
PHASE ELECTRIC INC.
9917 Lyndale Ave S
Bloomingto MN 55420
(952) 881-4 ] 00
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.
Ga
Applicant/Permitee: Signature ^ssued By: Signature