Electrical Permit - Permit# L 21-30 - 4688 West Arm Road - 8/12/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
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Date Issued: Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES 8ubfrotai
A. MINIMUM FEE PER INSPECTION TRIP
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
Additional Inspection trips for Reinspectionf8onding/Equipotential Plane/etc. $ 40.00 per
B. RESIDENTIAL One and Two-family dwelling units Up to 3 trips included in fee
1. New Dwelling Unit, up to and including a 200 amp service $ 125.00 per unit
2. New Dwelling Unit, 201 amp to 400 amp service $ 175.00 per unit
3. Existing Dwelling Unit, additions, alterations, or repairs up to & including a 200 amp service,
fees as per C & D below but not to exceed $ 125.00 per unit
4. Existing Dwelling Unit, additions, alterations, or repairs 201 amp to 400 amp service
fees as per C & D below but not to exceed 175.00 Der unit
5. New or Existing Dwelling Unit, 401 amp service or above See C & D below
. FEES FOR NEW OR UPGRADED SERVICES, TEMP. SERVICES,GENERATORS,
OTHER POWER SUPPLY SOURCES FEEDERS TO SEP STRUCTURES
1. Up to and including a 200 amp service $ 50.00 each
So.'!R.
2.201 amp to and including 400 amp service $ 100.00 each
3.401 amp to and including 800 amp service $ 200.00 each
4.801 amp service and above $ 300.00 each
D. FEES FOR CIRCUITS/FEEDERS B TRANSFORMERS
0 to 200 am $ 10.00 per circuit
Above 200 am $ 15.00 per circuit
Transformers up to 10 KVA $ 20.00 each
Transformers over 10 KVA $ 30.00 each
E. MULTI -FAMILY DWELLINGS
Each dwelling unit $ 50.00 per unit
F. ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
Each System Device or Apparatus $ .50 each
:Vlitiit€' BEGIN QR f INFSHF. # IiYf f#'fRIT 1S #E REQttiltEQ IN~FIMkW77
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
Do not forget State Surcharge Fee
S%
You must call 952442-7520 when work is ready for inspection!
Describe Proposed Work: G ho"il2 ou7r Men--rv2
Separate Permits are required for any building, mechanical, fire, or plumbing work.
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: q � g a UV ES T' ARr\ R, () Spring Park, MN Zip:
OR Legal Description: Lot:
Block:
Property ID (PIN No): 1 �S 11 `7 Z. 3 33 60 q1
Applicant is: Contractor: ❑ Or Owner:
Subdivision:
Contractor/Company Name: License #:
Address: 17 a 8 W,!F5 F Aep, go City/State: 5MW6, P,az,t Zip:
Telephone: Office/Home: (4,a ) 3 �1 - ? `I po Mobile: (� -
E-mail: Co 6 (cA iS , MA�4?Nt: , e_'OlviFax:
Builder/Owner Name: GA,4T-Z lz
Address (if dif£ from Site): City/State: Zip:
Telephone: Office/Home: Mobile: (( I) "K3 `( - `� 19 a
Fax: ( )
I HEREBY APPLY FOR AN ELECTRICAL PERMIT, AND I ACKNOWLEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND ACCURATE; I
UNDERSTAND WORK IS NOT TO START WITHOUT A PERMIT. I UNDERSTAND AND HEREBY AGREE THAT THE WORK FOR WHICH THE
PERMIT IS ISSUED SHALL BE PERFORMED ACCORDING TO THE FOLLOWING: (1) THE CONDITIONS OF THE PERMIT, (2) THE APPROVED
PLANS AND SPECIFICATIONS, IF NEEDED (3) THE APPLICABLE CITY APPROVALS, ORDINANCES, AND CODES, AND (4) THE STATE
BUILDING/ELECTRICAL CODE. I UNDERSTAND THAT THE PERMIT WILL EXPIRE, AND BECOME NULL AND VOID IF WORK IS NOT
COMPLETED WITHIN 12 MONTHS OF VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE REQUESTED IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE. >
Signa / c� Date: �/ i< /20 z
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surchar¢e in payment)
❑ Check attached — Check #
MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspect.com
FAX: 952-442-7521
MAIL/DELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
❑ Visa/Master Card —
Account Number
Credit Card Owner Billing Address: 1 S 33 W , 3 (LD A41C
Street Address
Payment Authorization Signature (REQUIRED)
$ '!; � '/ ( o
tApt anon CS V Amount to be withdrawn
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City, State Zip Code
Print Name on credit card (REQUIRED)
MNSPECTLLC
— 11- sll- West Wac—, MN —.11-
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Rob Schatzle
Sales Receipt
Date
Sale No.
8/12/2021
7386
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-30 - 4688 West Arm Rd
50.00
50.00
Electrical Inspection/Permit Fee - L21-31 - 4684 West Arm Rd
50.00
50.00
State Surcharge - Electrical
2
1.00
2.00
Total $102.00