Electrical Permit - Permit# L 21-35 - 4690 West Arm Road - 8/25/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Perna # L'Ll 3
Date Issued: 2q 7i 1 Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES subrrotal
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 Reinspection/Bonding/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 per unit
5. New or Existing Dwelling Unit, 401 amp service or above See C & D below
C. 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
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 & 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
G. WORK BEGUN OR FINISHED WITHOUT PERMIT IS 2X THE REQUIRED PERMIT FEE
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
Do not forget State Surcharge Fee
You must call 952442-7520 when work is ready for inspection!
Describe Proposed Work: 0k- `tz q (—`-
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: 1-11i %O (Al c ST 149-t-I /WO Spring Park, MN Zip: 5S5'38 _
OR Legal Description: Lot:
Block:
Property ID (PIN No): / 2// 7 z 3 3 3 0039
Applicant is: Contractor: ❑ Or Owner: El
Subdivision:
Contractor/Company Name: 2a"D'f J3;cJr✓Pl-+"A/ License #:
Address: y6 %D W e3 % A4,1-1 !LD City/State:
Telephone: Office/Home: ( ) - Mobile: ( -
E-mail:
Builder/Owner Name: _ _/< .,Vo S/ /3 i`G,�rrgn�iy
Address (if diff. from Site):
177M.
Zip:
City/State: Zip:
Telephone: Office/Home: Mobile: G( 761, U -
E-mail: 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 1S 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.
Signature: `i I� ��. —> ��—, �.� Date: Z 3
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surchare�e in Payment)
A Check attached — Check # / % % 5 19- MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspect.com
FAX: 952-442-7521
MAILMELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
❑ Visa/Master Card —
Credit Card Owner Billing Address:
Account Number
Street Address
Payment Authorization Signature (REQUIRED)
Expiration Date CSV
City, State
Print Name on credit card (REQUIRED)
Amount to be withdrawn
Zip Code
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Randy Bickmann
Sales Receipt
Date
Sale No.
8/25/2021
7402
Payment Method Check No.
Check 11732
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-35 - 4690 West Arm Rd
State Surcharge - Electrical
50.00
1.00
50.00
1.00
Total $51.00