Electrical Permit - Permit# L 22-05 - 4208 West Arm Drive - 1/18/2022LY
CITY OF SPRING PARK Electric OFFICE USE ONElectricP 1'
ELECTRICAL PERMIT Dale Isrwt;_--
PLEASE PRINT OR TYPE ALL INFORMATION A.N.@ COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES 5ubrrotal
A. MINIMUM FEE PER INSPECTION -TRIP
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per $ 40.00
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. NewDwellingUnit up to and including a 200 amp service $ 125.00 per unit
2. New Dwelling Unit, 201 amp to 400 amp service--$175.00per 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 pper 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 --- �-v
C. FEES FOR NEW OR UPGRADED SERVICES, TEMP. SERVICES, GENERATORS,
OTHER POWER,SUPPI. SOURCES, OR FEEDERS TO S P_ tit R S
1. Up to and, includin a ?90 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 nm service and above - $ 300.00 each
D. FEES FOR CIRCUITSJFEEDERS & TRANSFORMERS
0 to 200 amp_ $ 10.00 per circuit
Above 200 am $ 15.00 per circuit
Transformers u to 10 KVA — --- ► 20,0.0 each
f _ _
Transformers over 10 KVA $ 30-00 each
__. E. MULTI -FAMILY DWELLINGS —
- - _ --- -------------
Each dwelling unit $ 50.00 per unit
F. 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) 1.00
TOTAL AMOUNT DUE 141.00
k State Surcharge Fee)
You must call 952442-7520 when work is ready for inspection!
Describe proposed Work:
ELECTRICAL WORK FOR ELECTRIC FIREPLACE
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: 4208 WEST ARM DRIVE
OR Legal Description: Lot: Block:
Property ID (PIN No):
Applicant is: Contractor: V Or Owner: ❑
Contractor/Company Name: Fireside Hearth & Home
Address: 2700 FAIRVIEW AVE N
Spring Park, MN Zip:
Subdivision:
License #: EA7
City/State: ROSEVILLE/MN Zip: 55113
Telephone: Office/Home: ()651-633-2561 Mobile: () -
E-mail: ROSEVILLE_BUILDER_OPS@HNICORP.COM Fax: ( )
Builder/Owner Name: MARY ANN MILLER
Address (if dill. from Site):
Telephone: Office/Home: (612 ) 701
E-mail:
City/State:
- 4278 Mobile: ()
Fax: ( ) -
Zip:
I HEREBY APPLY FOR AN ELECTRICAL PERMIT, AND 1 ACKNOWLEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND ACCURATE; I
UNDERSTAND WORK IS NOT TO START WITHOUT A PERMIT. 1 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 REQUESTED IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Signature: , &za4 ,!YWd� Date: 1/12/22
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in uavment
❑ 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
❑ Vis a�eCar-- , $
Account Number Expiration Date CSV Amount to be withdrawn
Credit Card Owner Billing Address:
Street Address City, State Zip Code
L
Payment Authorization Signature (REQUIRED) Print Name on credit c 1 (REQUIRED)
[ - —M N LLC
_T
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Fireside
Sales Receipt
Date
Sale No.
1/18/2022
7530
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L22-05 - 4208 West Arm Dr
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00