Electrical Permit - Permit# L 21-36 - 3854 Sunset Drive - 9/1/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Per it # L 'L 3�O
Date Issued: Wi u 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
LM on
_
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 Dwellin Unit, u 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 Der 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 eachli
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 yI
(Do not forget State Surcharge Fee) /
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: t.J I r
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11` C 1K7 i Cf R r c'
Separate Permits are required for any building, mechanical, fire, or plumbing work. pp
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C"2a-z O
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: 3 6 S q Su, 5e i Dr. Sprin; Park, MN Zip: S 3'* y
OR Legal Description: Lot:
Property ID (PIN No):
Applicant is: Contractor: ❑
Contractor/Company N
Block:
Or Owner: ❑
Subdivision:
e5f--1 S l ( • License #: �A bb % Li (�
Address: co_n'C y RA 3o City/State: �JCtt -v')t� ��� 1� Zip:
Telephone: Office/Home: ( ) - Mobile: (6 12 ) "71F - C 9 9 C�
E-mail: �c S '�-y S <, \,Irc- G Nl .�.0 ^4,1 Fax:
Builder/Owner Name: e T -� �;n�"r
Address (if diff. from Site): 't City/State: Zip:
Telephone: Office/Home: ( ..... )
E-mail:
Mobile: (�
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
BUILDINGIELECTRICAL 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 RECONFORMANCE WITH THE STATE BUILDINGIELECTRICAL CODE.
Signature: QUESTED Date:
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in payment)
❑ Check attached — Check #
MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspect.com
FAX: 952-442-7521
MAILMELIVER: MNSPECT, 235 West First 4trf-et Wn;i ?%AXT sc187
,w- Visa/Master Card —_ ^
Account Number �% hxptration Date CSV Amount to be «,ithdrawn
Credit Card Owner Billing Address: B 03 � r, ,A,4 ��^ � Q 14G1, G-- rlN S 5'� s7 7
Street Address �-City, State Zip Code
zzz' �A4, H l✓s����
a went Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Westys Electric
Sales Receipt
Date
Sale No.
9/ 1 /2021
7407
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-36 - 3854 Sunset Dr
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total 1.,,,,