Electrical Permit - Permit# L 21-46 - 3800 Northern Avenue - 12/17/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Perri # L 0-
Date Issued: 2 / / 7 L Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES Sub/Total
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
mob,
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 e175.00 er 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
i
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
777�-
a• , hUT��QR`FIyIStEpSXHQ11REDPERMITFEE ,WITHOUT PERMIT
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
Do not forget State Surchar a Fee
You must call 952-442-7520 when work is ready for inspection!
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: _ 3�OU 2AL�- Springy brk,NW Zip.., S-, q
OR Legal Description: Lot:_ Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor:' Or Owner: D
Contractor/Company Name:
Qkti)
Ll License#: h,�- 41
Address:
City/State :-jyt:q-k,L a&zip:-:�6; (
Telephone: Office/Home: Mobile: (
E-mail: Lf*� � 1-:- Li- L(27-0,T-P-2 aL G (n1:1,i U,�A Fax:
Builder/Owner Name: t-�,Jr S ---
Address (if dill. from Site): :3b 0
x V U-
City/State:Zip:
Telephone. Office/Home:
Mobile:
E-mail:--�u n--P fz-
IL �t- ,
I HEREBY APPLY FOR AN ELECTRICAL PERMIT, AND [ACKNOWLEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND ACCURATE; I
UNDERSTAND WORK IS NOT TOSTARTWITHOUT 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 I MONTHS OF VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRE INSPECTIONS ARE REQ STED IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE. D
Signature: Jm
Date:
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Su. a in Pavment
0 Check attached - Check # MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical spect.com
: 2-442-7521
MAIL/DELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
-Visa/Master Card - 2(Po
_�T��Account Number Expiration Date
CSV
Credit Card Owner Billing Address: Amount t, be �withdmiw,
Street Address City, State
Zip Code
Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
g.N �,-.
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Pride Electric
Sales Receipt
Date
Sale No.
12/ 17/2021
7509
Payment Method Check No.
MastcrCard
Description
Qty
Rate
Amount
Electrical Inspection/Pennit Fee - L21-46 - 3800 Northern Ave
State Surcharge - Electrical
80.00
1.00
80.00
1.00
Total $81.00