Electrical Permit - Permit# L 21-37 - 3862 Northern Avenue - 9/7/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Per i n# L 24 —'V 7
Date Issued: li Receipt M
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity Ut5GRIPTION OF WORK
FEES SubfTotal
---_-
MINIMUM FEE PER INSPECTION -TRIP-
Includes 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 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 repaint 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
er 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,
ER P WER UPPLY SOURCES OR FEEDERS TO SEP STRUCTURES
1. Up to and In uding a 200 amp service $ 50.00 each
_
2.201 amp to and includina 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 CIRCUITSIFEEDERS_ & TRANSSFORMERS
0 to 200 am --
- $ 10.00 per circus
Above 200 am $ 15.00 per circus
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 uniF. t
ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS_THAN 50 VOLTS
Each System Device or Appara.us @ $ .50 each
. 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_952-442-7520 when work is ready for inspection!
Describe Proposed Work:
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 i
L�OZ-
n
Q i1(�l �i
Spring Park, MN
Zip: 55�
OR Legal Description: Lot:
Block:
Subdivision:
Property ID (PIN No):
Applicant is: Contractor: Or Owner: 0
Contractor/Company Name: �Jyll'(Se �[2 C.._�( ^^ License #: EA Q7 1-1
Address: C4aso - 83YCL enY rp City/State: _Roo, �'
Zip: SJ14q-09 wh,
Telephone: Office/Home: (203) 5(0Zb -BUM Mobile: tom) 3(03
E-mail: S LMU'1 &a6ZC 4 Q,yyfsfchllfQ fie)' Fax: (_)
Builder/Owner Name: M nI I? e- Mc
Address (if diff. from Site):
City/State: Zip;
Telephone: Office/Home: (__) - Mobile: ( )
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 WI 7 HO rr A PERMIT. I UNDERSTAND AND HEREBY AGREE THAT TILE WORK FOR WHICH THE
PERMIT IS ISSUED SHALL BE PERFORMED ACCORDING TO TI1E 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
BUILDINGTLECTRICAL CODE. 1 UNDERSTAND TIIAT THE PERMIT WILL EXPIRE, AND BECOME NULL AND VOID IF WORK IS NOT
COMPLETED WITHIN 12 MONTHS OF VALIDATE ATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE RE U DIN CONFORM C . WITH THE STATE BUILDING/ELECTRICAL CODE. (�
Signature: Date: ['
o 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
r
Visa/Master Card — _ a 5 I '�
Account Number ,,,,.y Expiration Date „l Amount to be withdrawn
Credit Card Owner Billing Address: _SL60 _ / d �� _r o N & k M, V SS /1 1 i
Street Address City, State Zip Cod`c( �7`-+
In6-I
Payment Authorization Signature (REQUIRED) Print Name on credit card QUIRED)
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Sunrise Electric
Sales Receipt
Date
Sale No.
9/7/2021
7408
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-37 - 3862 Northern Ave
State Surcharge - Electrical
50.00
1.00
50.00
1.00
Total $51.00