Electrical Permit - Permit# L 21-31 - 4684 West Arm Road - 8/11/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Permit # L 2-1 —3 1
Date Issued: Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES Sub/Total
A. MINIMUM FEE PER INSPECTION TRfP
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
Additional Inspection trips for Reinspection/Bonding/Equipotential Plane/etc. $ 40.00 per
B. RESIDENTIAL One -and Tworfamly 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 per 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, OR FEEDERS TO. SEP STRUCTURES
/
1. Up to and including a 200 amp service $ 50.00 each
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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 CIRCUOSfFEEDERS & 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+AMILY DWELLINGS
Each dwelling unit $ 50.00 per unit
. ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ $ .50 each
+0 i•HEltE RE YIIT FEIr,
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
Do not forget State Surcharge Fee
00
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You must call 952442-7520 when work is ready for inspection!
Describe Proposed Work: wi t oy%� /?/!� `j �A✓� F IL
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: LIDO gy 6vJE5 i AZ/r 1 2D Spring Park, MN Zip: SS3�
OR Legal Description: Lot:
Block:
Property ID (PIN No): I Z<< `7 2- 3 3 3 Oy0
Applicant is: Contractor: 0 Or Owner:
Subdivision:
Contractor/Company Name: License #:
Address: �6gy WET A2y% IeD City/State: Zip: SY3 g5'
Telephone: Office/Home: ( (a } 3 - 9 i % o Mobile: (___) -
E-mail: % b ® GO 1%1 Fax:
Builder/Owner Name: -�a b
Address (if dill. from Site): City/State: Zip:
Telephone: Office/Home:
E-mail:
Mobile: (( t Z ) g3 l- 9 7 9'D
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 MONTAS OF VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE REQUESTED IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Date: V, /
PAYMENT MUST ACCOMPANY APPLICATION fBe sure to include State Surcharge in Davment
❑ Check attached — Check # MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspect.com
FAX: 952-442-7521
MAH.JDELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
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0. Visa/Master Card — ���
Acc.unl N mtber Expiration Date CSV Amount to be withdrawn
Credit Card Owner Billing Address: l533 W . 3 RZ AV S{ AI<!oPeEF MAI
Street Address City, StateC Zip Code
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Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)