Electrical Permit - Permit# L 21-47 - 2425 Black Lake Road - 12/28/2021OFFICE USE ONLY
CITY OF SPRING PARK Electric Permit# L 7-1 -f , -7
ELECTRICAL PERMIT Date issued. ('1112- 7 u—R..* #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES Subff otal
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00pie—r
per
Additional Inspection trips for Reinspection/Bonding/Equipotenb�40,60 p
aI Plane/etc. er
1. New Dwelling Unit, up to and including a 200 amp service $ 125.00 pqr unit
. ...... ......
2. New Dwellinq 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 I
fees as per C & D below but not to exceed $,175,00-pe I _tunitl
5. New or Existing Dwelling Unit, 401 amp service or above See C & D bef&;4
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 tq_and including 200.00 each
4.801 amp service and above $ 300.00 each
0 to 200 amp $ 10.00 per circuit
Above 200 amp $ 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, COMMU,NFCATI—ON,-SIGNALING —CIRCUITS, OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ $ .50 each,
State Surcharge .0005 of the permit fee (minimum of $1.00) 1.00
TOTAL AMOUNT DUE $ yt.—
ptforget State Surcharge_Fee
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: 0"� -T koy)i�' t 1c I , , O-Qz N-ry) to
Md
W
Separate Permits are required for any building, mechanical, fire, or plumbing work.
I a
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
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Job Site: Street Address: — 4� ql� j I ! ,,, 0, "1- Spfing Park. MN Zip:
OR Legal Description: Lot:
Property ID (PIN No):
Applicant is: Contractor: Or Owner: f_1
1 -12 rim
Subdivision:
Contractor/Company Name: L — 1c, License#: 0:�6L2_Yf)
Address: ity
-C/State: (�rzs_W I-
zip::�I'
Telephone: Office/Home:/ �Y) l"j,
Mobile:
E-mail: I �' ) r �() i i � , .fax:
CIL
Builder/Owner Name: 11'Wr_�L Aim l (I'Ah)�
Address (if diff. from Site
Telephone: Office/Home: (
E-mail:
Mobile:
City/State:
Fax: (_) -
Zip:
I HEREBY APPLY FOR AN ELECTRICAL PERMIT, AND I ACKNOWLEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND ACCURATE; I
UNDERSTAND WORK 15 NOT TO START WITHOUT A PEP —,MIT. 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 I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE RTESTED IN CONFORMANCE WITH THE STATE BUILDINGIELECTRICAL CODE.
Signature: Date:
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharg_e in ayment)
o Check attached - Check # MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspect.com
FAX: 952-442-7521
MAIUDELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
o Visa/Master Card - - , -
Credit Card Owner Billing Address:
Account Number
Street Address
$ 2(. -_
Expiration Date CSV Amount to be withdrawn
City, State Zip Code
Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
n
M N S i7W
P�E�CTLLC
iAY�` . °DLL
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Pride Electric
Sales Receipt
Date Sale No.
12/27/2021 7515
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-47 - 2425 Black Lake Rd
State Surcharge - Electrical
80.00
1.00
80.00
1.00
Total $81.00