Electrical Permit - Permit# L 21-44 - 4177 Shoreline Drive #224 - 12/9/2021COFFIC E USE ONLY
CITY OF SPRING PARK
Electric Permit# L
ELECTRICAL PERMIT Date Issue& Receipt 4
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity
DESCRIPTION OF WORK FEES
Sub[Total
- - - --- ------
MINIMU M FEE PER INSPECTION TRIP
2.
includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
g 0
Additional Inspection trips for Reins pection/Bonding/EquipotentiaI 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
2. New Dwellinq Unit, 201 amp to 400 am service $ 175.00 per unit
p
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_riper C & D below but not to exceed 175.00 r unit __
5. New or Existing Dwelling Unit, 401 amp service or above See C & D below
&_._FEtS_ FOR NEW OR UPGRADED SERVICES, TE—M—P.SE-R-MICES, GENERATORS,
OTHER POWER SUPPLY SOURCES, OR FEEDERS TO SEP. STRUCTURES
1. Up to and including a 200 amp service $ 50.00 each
2. 201 amp to and including _4qP_amp _service $ 100.00 each
3. 401 amp to and includin 9 800_arrip se $ 200.00 each
4. 801 amp service and above $ 300.00 each
D. FEES FOR CIRCUITSIFEEDERS & TRANSFORMERS
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 dwellin unit 50.00 per unit
ALARM, COMMUNICATION*SIGNALING THAN 50 VOLTS
Each S stem Device or Ap arat s -- $ .50 each
PERMIT FEE
State 4,m, E
urcFiarge fl"T P 'Ww"of"the ermit fee (minimum of $J.00)
1.00
TOTAL AMOUNT DUE
$
'Do not forget State SurqharqeFe�q)___
X7-.- 111111 ChLIOW A A,% AT_-0%A ___v_
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTn PAGES
Job Site: Street Address ^` t J ] j 5�(4 11'Af A_ Spring Park, MN -Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor: Or owner: El
ontractor/Company Name:_ MT K P(opo4i'tj License #:
t
Address: City/State: Zip:___
Telephone: Office/Home: 2__ Mobile:
E-mail: Fax:
Builder/Owner Name: 1AkSJ+,qK 0YA('C'
I '
Address (if. diff. from Site): t3o3. Cvvf-t 7?() —city/State: tAA C --q, M L/ zip: S 5 3k7
Telephone: Office/Home: Mobile: (_4/2- )_7(1
E-mail:— Wr c, k�j C')!5 1, 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) TILIE 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 A D IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Signature: Date:
U N S PEC�T,LC
�' '
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Westys Electric
Sales Receipt
Date
Sale No.
12/9/2021
7499
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-44 - 4177 Shoreline Dr unit
80.00
80.00
224
Electrical Inspection/Permit Fee - L21-45 - 4177 Shoreline Dr unit
80.00
80.00
324
State Surcharge - Electrical
2
1.00
2.00
Total $162.00