Electrical Permit - Permit# L 21-32 - 4230 West Arm Drive - 8/24/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Pepp L `Zf -3Z'
Date Issued. 2`� 1il Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES subtrotal
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 Reinspection/Bonding/Equipotential Planeletc. $ 40.00 per
B. RESIDENTIAL One and Two-family dwelling units Up,to 3 trips inctuded in fee
1. New Dwelling Unit,.up to and includinga 200 am 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 oer C & D below but not to exceed 175.00 er unit
__
5. New or Existing Dwelling Unit, 401 amp service or above See C & D below
C. 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
2.20 am to and includin 400 am service $ 100.00 each
3.401 am to and includin 800 am service $ 200.00 each
4. 801 amp service and above $ 300.00 each
D. FEES FOR CIRCUITS/FEEDERS & TRANSFORMERS
0 to 200 am $ 10.00 per circuit
Above 200 am $ 15.00 oer 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
, ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 5o VOLTS
Each System Device or Apparatus @ $ .50 each
..WORK BEGUN OR FINISHED, WiTHO.UT PERMIT IS 2X THE REQUIRED FERMI f FEE
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
Do not for et State Surcharge Fee
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: �' j,� ( IL
Separate Permits are required for any building, mechanical, fire, or plumbing work.
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PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: Z d f QYj Spring Park_ MN Zip: SS3
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor:, Or Owner: ❑
Contractor/Company Name:. Powerhouse Electric, Inc
Address:
Tel —hone: Off /H
1958 Raspberry Lane
Shakopee, MN 55379
12AC03631 AM-06915
Ic1e ome. (_ 952-233-5404 952-292-4981 -
E-malls s" i'li.l;ij� _ �` CL�. r'��v�1�t+ �= L1.�1 Fax;
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Builder Name:
License #:
Zip:
Address (if diff. from Site): 4 Li3 6 WejP AYhi M re-
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City/State: (' c i't Zip:
Telephone: office/Home: ( Z) S _ ( 21S Mobile:
E-mail: r
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 PFRMTI. I UNDERSTAND AND HEREBY AGREE THAT THE WORK FOR WHICH THE
PERMIT IS ISSUED SHALL N , IF NEEDED
ACCORDING To THE FOLLOWING: (1) THE CONDITIONS OF THE PERMIT, (2) THE APPROVED
PLANS AND SPECIFICATIONS, !F 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 ATITE N 12 MONTHS OF VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE REQUESTED IN CONFORMANCE WI!__,� STATE BUIL�IINGIELECTRTCAL CODE.
Signature:
Date: il 1/—z-/
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in navment)
❑ Check attached — Check # MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electricat@mnspect.com
FAX: 952-442-7521
MAIL/DELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
e/visa/Master Card — _ $ a
Account Number Expiration Date CSV Amount to be withdrawn
Credit Card Owner Billing Address: ( `� n% --6. 37 — {--
Street Adds City, State Zip Code
F.sWent Authorization Si nature (REQUIRED) Print Name on credit card (REQUIRED)
'Mm
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Powerhouse Electric
Sales Receipt
Date
Sale No.
8/24/2021
7398
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-32 - 4230 West Arm Dr
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total I �)O