Electrical Permit - Permit# L22-02 - 3836 Sunset Drive - 1/7/2022CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Permit # LZ 2 -O
Date Issued: i % LL Receipt
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES Subrrotal
`: MINIMUM FEE Pi=R 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 tr ps.1ncludedIn fee
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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
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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
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5. New or Existing Dwelling Unit, 401 amp service or above See C & D below
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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
FQR CIRCUITStFEEDERS'8 TRANSFORMERS . ,777777
_ 0 to 200 amp $ 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 DVIIELLINGS
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Each dwelling unit _ $ 50.00 per unit
ALARM; COMMUNICATION, 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
Do not forget State Surcharge Fee)
$
You must ca11952-442-7520 when work is ready for inspection.
Describe Proposed Work:
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Separate Permits are required for any building, mechanical, fire, or plumbing work.
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PLEASE PRINT OR TYPE ALL INFORMATION,AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: - c5u-5z' 1) C%, C Spring Park, MN Zip: 5-0)51y
OR Legal Description: Lot:
Property ID (PIN No):
Block:
Subdivision:
Applicant is: Contractor: j751 Or Owner: ❑
Contractor/Company Name: +'� l ,�'e:t License #:£A01zFz
Address: �6 -`� �y.�� U►�-�� City/State: t� A)Zip: s�
Telephone: Office/Home: (751, ) 915 - ZZ7L Mobile:
E-mail: t C-,++ rV be-Y' `- A: low t lta iC . CCr"t Fax: ( )
Builder/Owner Name:
Address (if diff. from Site):
IL0,10 P,t^. / I—u
Telephone: OfficeMome: ( )
E-mail:
City/State: Zip:
Mobile: (61Z ) ?oZ - ZZ1.9
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. E U, IDERSTAND AND HEREBY AGREE THAT THE WORK FOR WHICH T14E
PERMIT IS ISSUED SHALL BE PERFORMED ACCORDING TO THE FOLLOWING- (I) 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
BL'ILDING.IELECTRICAL CODE. I UNDERSTAND TIIAT THE PERMIT WILL EXPIRE. AND BECOME NULL .AND VOID IF WORK IS NOT
COMPLETED *-L'�IE THS F VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS RE REQ TED N ONFORMANCE WITH THE STATE BUILDINWELECTRICAL CODE.
Signature: Date:
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PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in pavment) 0
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❑ Check attached — Check # MAKE CHECKS PAYABLE to MNSPECT Z�
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EMAIL: electrical@mnspect.com k
FAX: 952-442-7521
MAIL/DELIVER: MNSPECT. 2"lS Wnet P,* - t Qn-..ter iht.,,., -;, r,n.1 c«0'7
Visa/Master Card - I - - - - - _ S ,
.Account Numher ` Expiration Date CSV Amount�tyo be with yawn
Credit Card Owner Billing Address: XV W t')6'dt.Ae' bl.s I 46." 144-
1 Street Addres ;^�Citgtate Q Zip Code
Pavmen uthorizatio Signature (REQUIRED) Print Name on credit card (REQUIRED)
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952-442-7520 Fax 952-442-7521 888-446-1801
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Milow Electric
Sales Receipt
Date
Sale No.
1/10/2022
7519
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L22-02 - 3836 Sunset Dr
State Surcharge - Electrical
125.00
1.00
125.00
1.00
Total S126.00