Electrical Permit - Permit# L21-43 - 4238 West Arm Drive - 11/1/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric PeriTpt# L 2 (- q 3
Date Issued: % / 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
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
7
2. New Dwelling Unit, 201 amp to 400 amp service $ 175.00 per unit
1
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 includina a 200 amp service $ 50.00 each
2. 201 amp to and including 400 amp service ____.._ $ 100.00 each
3.401 amp to and including800 amp service .............__.. $ 200.00 each
_
4. 801 am service and above $ 300.00 each
D. FEES FOR CIRCUITS/FEEDERS & TRANSFORMERS
0 to 200 amp $ 10.00 per circuit
Above 200 am $ 15.00 per circuit
Transformers up to 10 KVA 20.00 each
$ 30.00
Transformers over 10 KVA 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
_ _.
=WOR1{ AEG N OR`FIl�15HED.. ,. � C1UT PERIT 1S�C THE`REC�UIRED PERMITFEE :`:
M
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: AJd C U `nt'E=� 2 ��
I
Cl46ve-
Separate Permits are required for any building, mechanical, fire, or plumbing work.
U) �6�
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: L4' )- 3 g W E5 /gym tD (Z-- Spring Park, MN Zip: SS 3 9 `f
OR Legal Description: Lot:
Property ID (PIN No):
Block: Subdivision:
Applicant is: Contractor: A Or Owner: ❑
Contractor/Company Name: H'A'N G60 (. IM6 S f 51&71 S License #: L54CO3G3 i
Address: woo City/State: Ems/ �� Zip:SsY�Y
Telephone: Office/Home: () - Mobile: ([P (t2
E-mail: G� y.-(�Suw (J ��Sysfi �N`� �G�►-. Fax: (� -
Builder/Owner Name:
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 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 IS NOT
COMPLETED WITHIN 12 MONTHS OF VALIDATED DATE AND, THAT 1 AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE REQUE D IN CON ORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Signature: Date: 02 a4a�
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
MAIL/DELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
Visa/Master Card--
Account Number n , Expiration Date CSV Amount to Ibe withdrawn
Credit Card 4B'gress: `YG D V�'l r.[� Vle_y /�' �lNA phStreet Address City, State Zip Code
Paymen Anature (REQUIRED) Print Name on credit card (REQUIRED)
7 M N S P E Cc:
n ooQ
i a
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Enhanced Home Systems
Sales Receipt
Date
Sale No.
11 / 1 /2021
7468
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-43 - 4238 West Arm Dr
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00