Electrical Permit - Permit# L21-40 - 4164 Shoreline Drive - 10/4/2021CITY OF SPRING PARK OFFICE USE ONLY
ELECTRICAL PERMIT Electric Per it # L I
Date Issued: � `i L � Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK
FEES Sub/Total
. MINIMUM FEE PER INSPECTION TRIP
tlIncludes
up to 4 circuits if more than 4 see Sec. D below $ 40.Mfee
Additional Inspection trips for Reinspection/Bonding/Equipotential Plane/etc. $ 40.
B. RESIDENTIAL One and Two-family dwelling units Up to 3 trips Included
1. New DwellingUnit, u to and includinga 200 am service $ 125.02.
New Dwellin Unit, 201 am to 400 am service $ 175.03.
Existing Dwelling Unit, additions, alterations, or repairs up to & including a 200 amp servifees as per C & D below but not to exceed $ 125.004.
Existing Dwelling Unit, additions, alterations, or repairs 201 amp to 400 amp service
fees as er C & D below but not to exceed 175.00
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
. ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ $ .50 each
. WORK BEGUN OR FINISHED WITHOUT PERMIT IS 2X THE REQUIRED PERMIT FEE
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
Do not forget State Surchar a Fee
y ��
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: 7F�pZgjgy lyeN
11�
Separate Permits are required for any building, mechanical, fire, or plumbing work.
J
PLEASE PRINT OR TYPE ALL INFORVION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: L1 W q �l'1DYe IYiQ� Spring Park, MN Zip: S5�j$
OR Legal Description: Lot:
Property ID (PIN No):
Applicant is: Contractor: 4 Or Owner: ❑
Block:
Subdivision:
Contractor/Company Name: MV(Itnctcl Ueciij ci 7 yq ices n 1,icense #: E70Q[DLOf4
Address: �� �a-� City/State: �_Zip: 56
Telephone:: ,O�ffi.,ce/Home:_l(�N Lk - s� Mobile: (�o� 3-
E-mail:�^N�l�l , V i@ a (�I�A i� AE'.'dt 6�1((il `CP V V I(,�6 YY1 V1 Fax:
Builder/Owner Name:
Address (if diff. from Site):
City/State:
Telephone: Office/Home: () - Mobile: (__)
Fax:
Zip:
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 ((2 THE STATE
BUII DING/EI ECTRICAL 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 REQU RED
INSPECTIONS A QUESTED IN- XORNVNCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Signature:
Date: 1113
PAYMENT MUST ACCOMPANY APPLICATION Be sure to include State Surcharge in payment)
11Check 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
Visa/Master Card — _ _ $ 1. k - O O
Account Number
Ave,Expiration Fate CSV Amount to be withdrawn
Credi owner Billing Address: 15 k A Iew.Ny N i Nn ^, _�� al oR
Street Address Crty�, fate
Zip Code
tU st1 II M AC k.Eu�\j jxA
Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Advanced Electrical
Sales Receipt
Date
Sale No.
10/4/2021
7437
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-40 - 4164 Shoreline Dr
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00