Electrical Permit - Permit# L 22-08 - 4469 Lafayette Lane - 1/20/2022CITY OF SPRING PARK OFFICE USE ONLY
Electric Permit # L Zz-
ELECTRICAL PERMIT Date Issued: s z-T—Receipt#
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK
FEES Sub/Total
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
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
S
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
C. FEES FOR
OTHER POWER
NEW OR UPGRADED SERVICES, TEMP. SERVICES, GENERATORS,'
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
3. 401 amp to and including 800 amp service $ 200.00 each
4. 801 amp service and above $ 300.00 each
D. FEES FOR CIRCUITS/FEEDERS & TRANSFORMERS
0 to 200 am $ 10.00 per 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
F. ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ $ .50 each
�-P "°
; WOI BEGUN OR FINISHED WITHOUT PERMIT IS 2X THE REQUIRED P, EI4M(`f,FEE
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
(Do not forget State Surcharge Fee)
$
You must ca11952-442-7520 when work is ready for inspection!
Describe Proposed Work:
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: �y�/ l-R--t�� Ln Spring Park, MN Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor:, Or Owner: ❑
Contractor/Company Name: lla 027�— / C.04 G License #:
Address: /Y 3-3_h1)%i b,,- City/State:_ 1.14 Zip: 8
Telephone: Office/Home: U - Mobile: ( /2 )11S - -� CO
E-mail:
Builder/Owner Name:
Address (if dif£ from Site):
Telephone: Office/Home: (�
E-mail:
Mobile: (
Fax: ( -
City/State:
Fax:
Zip:
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 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:
Date: 1 %is — 2-2-
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
❑ Visa/Master Card -
Credit Card Owner Billing Address:
Account Number
Street Address
Payment Authorization Signature (REQUIRED)
Expiration Date CSV
City, State
Print Name on credit card (REQUIRED)
T
Amount to be withdrawn
Zip Code