Electrical Permit - Permit# L 22-06 - 4242 West Arm Drive - 1/18/2022CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Permit # L Z z -0(�
Date Issued: t C ZZ Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES sub/Total
. 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 ampservice $ 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 Der unit
5. New or Existing Dwelling Unit, 401 amp service or above See C & D below
C. FEES FOR NEW OR UPGRADED SERVICES, TEMP. SERVICES, GENERATORS,
OTHER POWER SUPPLY SOURCES OR FEEDERS TO SEP._STRUCTURES
1. U 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
D.FEES _FOR CIRCUITSIFEEDERS&TRANSFORMERS �..�:.�
0 to 200 amp _ _ $ 10.00 per circuit
Above 200 amp . $ 15.0opfe- 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
F. ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ $ .50 each
kIN 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
L?�
1.00
b wo
You must ca11952-442-7520 when work is ready for inspection!
Describe Proposed Work: �-�/t1 Y
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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
OR Legal Description: Lot:
Property ID (PIN No):
UJQ�� ' t i vi �h Spring Park. MN Zip:
Block: Subdivision:
Applicant is: Contractor:' Or Owner: ❑
Contractor/Company Name: License #: 3�Z
JDP ELECTRICAL SERVICES
1432 OAKPOINTE DRIVE City/State: /State: Zi
Address: wACONIA, hAN 55387 ty p'
Telephone: Office/Home: ( (o«) -jS ( - 415 Z Mobile: Q5 �- ) M *2- - Qq <�
E-mail: V"' Y-' .li %/'a ,I An S Q# fTAA'c .- 4i&Fax:
Builder/Owner Name:
Address (if diff. from Site): City/State: Zip:
Telephone: Office/Home: �)
Mobile: (�
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.W_ITHOUT A PERMIT. I UNDERSTAND AND HEREBY AGREE THAT THE WORK FOR WHICH THE
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
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 AU REQUgTED IN CONFORMANCE WITH THE §TATE BUILDING/ELECTRICAL CODE.
Signature:
Date: / /f 22
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in payment)
❑ 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
X- Visa/Master Card — _ _ _ _ . , _ .. $ 81.00
Account Number 'bAExpiration Date CSV Amount to
be
withdrawn
Credit Card Owner Billing Address: y 3 ` " j �Xa �� &+ /
Street Addres City, State Zip Code
6 of sxU , L VJ Jk� 2wevn L uj a^L1 at
Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
r -, � M N LLC
°
952-442-7520 Fax 952-442-7521 888-446-1801
RM156111110
JDP Electrical
Sales Receipt
Date Sale No.
1/18/2022 7532
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L22-06 - 4242 West Arm Dr
State Surcharge - Electrical
80.00
1.00
80.00
1.00
Total $81.00