Electrical Permit - Permit# L 21-45 - 4177 Shoreline Drive #324- 12/9/2021OFFICE USE ONLY
CITY OF SPRING PARK Electric Permit # L Z-r —q,
ELECTRICAL PERMIT Date Issued: + �; i Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK
FEES SubfTotal
2..
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
F
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 $ 175.00 per unit
5. New or Existing Dwelling Unit, 401 amp service or above See C & D below
. 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
__
2. 201 amp to and including 400 amp service $ 100.00 each
401 am to and including800 am service $ 200.00 each
3PFEES
service and above $ 300.00 each
R CIRCUITSIFEEDERS & TRANSFORMERSm
$ 10.00 er circuit
0 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
. ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ $ .50 each
. WORK BEGUN OR FINISHED WITHOUT PERMIT IS 2X THE REQUIRED PERMIT FEE
State Surcharge .0005 of the permit fee (minimum of $1.00)
TOTAL AMOUNT DUE
(Do not forget State Surcharge Fee
1.00
1?1 -Ob
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: OVA 9-"41 A'J k4
6A�Oc��
Separate Permits are required for any building, mechanical, fire, or plumbing work. r
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address( U',.I}
R Legal Description: Lot:
,.operty ID (PIN No):
S�o�c (,_r bt . Spring Park, MN Zip:
Block: Subdivision:
is: Contractor: & Or Owner: F1
Contractor/Company Name: �,1�s F t �"� t I License #: 6 !;
Address: , D 3 S (0 ti �4 City/State: a,,, , 0h . Zip: S 5 3 8 7
Telephone: Office/Home: ( } J0 Mobile:
E-mail: W, '5 �•lS� �t �''+ eei f t� j , r rw^ Fax: (� -
Builder/Owner Name: tT
Address (if diff. from Site): City/State: Zip:
Telephone: Office/Home: (o( ► Z } 97 - .7?�5_ Mobile:(_____)_-_
E-mail
Fax:
HEREBY APPLY FOR AN ELECTRICAL PERMIT, AND I ACKNOWLEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND ACCURATE; I
JNDERSTAND WORK IS NOT TO START WITHOUT A PERMIT. I UNDERSTAND AND HEREBY AGREE THAT THE WORK FOR WHICH THE
TRMIT IS ISSUED SHALL BE PERFORMED ACCORDING TO THE FOLLOWING: (1) THE CONDITIONS OF THE PERMIT, (2) THE APPROVED
'LANS AND SPECIFICATIONS, IF NEEDED (3) THE APPLICABLE CITY APPROVALS, ORDINANCES, AND CODES, AND (4) THE STATE
3UILDINGIELECTRICAL CODE. I UNDERSTAND THAT THE PERMIT WILL EXPIRE, AND BECOME NULL AND VOID IF WORK IS NOT
>OMPLETED WITHIN 12 MONTHS OF VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
NSPECTIONS ARE REQUE ED IN CONFORMANCE WITH THE STATE BUILDINGIELECTRICAL CODE.
signature: v Date: f Z 2 l
?AYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in payment)
i 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 to be withdrawn
Credit Card Owner Billing Address: � 0 3 S CbV�+ :qd Q �0AI C,,
Street Address City, State Zip Code
mLait I.1"r d
Payme t Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)