Electrical Permit - Permit# L22-03 - 4201 Sunset Drive - 1/7/2022CITY OF SPRING PARK OFFICE USE ONLY
ELECTRICAL PERMIT Electric Pgrmit # L z a -03
Date Issued- 1171: li R—ipt 0
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK
FEES Subrrotal
._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 oer unit
2. New DwellingUnit, 201 am to 400 am service $ 175.00 er 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 175,00 per -unit
5. New or Existing Dwelling Unit, 401 amp service orSee C & D below
_above
. FEES FOR NEW OR UPGRADED SERVICES, TEMP. SERVICES, GENERATORS,
OTHER POWER SUPPLY SOURCES OR FEEDERS TO SEP. STRUCTURES
1. U to and includin a 200 amp service _ ___ _ $ 50.00 each
2. 201 am to and including 400 amp service $ 100.00 each
3. 401 am to and including800 am service _ $200.00 each
4. 801_amp service and above _ $ 300.00 each
D. FEES FOR CIRCUITSIFEEOERS & TRANSFORMERS
0 to 200 am $ 10.00 er 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
----- OF LESS THAN 50 VOLTS
. ALARM, COMMUNICATION, SIGNALING CIRCUITS,
--- ---
Each System Device or Apparatus $ .50 each
FINt C THEBEQUIRE
'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 952442-7520 when work is ready for inspection!
Describe Proposed Work: Iilr� t " t Yn� -#-i CL "� V .
�1. " Lo ` &
`c I
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: Sprin�Park, MN Zip: i
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor: x Or Owner: ❑
Contractor/Company Name: LdC C, License #: 01MUL10.3
Address: M;G'11 N�a-A City/State: iY1 Zip",- i
Telephone: Office/Home: (—jqZ)) r Mobile:( -
E-mail: 'rn'�'-is@ i%tC C4rir1 Fax: {) _
1
Builder/Owner
Address (if diff. from Site):
�10- MOVE
Telephone: Office/Home: (} -
I E-mail:
City/State: Zip:
Mobile: (nU3)d(r) -
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 pYEI!?A E AND, TH RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE REQUESTED I CONFORMANCE W Tlj5i4TATE BUILDING/ELECTRICAL CODE.
_ Signature: a+K Date:
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in payment
o 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 Expiration Date CSv Amount
tttobe withdrawn
Card Owner Billing Address:
Street Address City, State Zip Code
M N S P E C TLLC
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Randy's Electric
Sales Receipt
Date
Sale No.
1/10/2022
7520
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L22-03 - 4201 Sunset Dr #522
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00