Permits - Permit# L22-10 - 3701 Sunset Drive - 2/4/2022CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Permit # L z 1-- ( 0
Date Issued:" , LZ- Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES subrrotai
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
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 ver 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. 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
. ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ $ .50 each
hT IS 2X THE REQUIRED PE, MUZ
State Surcharge .0005 of the permit fee (minimum of $1.00)
TOTAL AMOUNT DUE
7 Do not forget State Surcharge Fee
EL
1.00
Q 1
You must ca11952-442-7520 when work is ready for inspection!
Describe Proposed Work:- i hJ S �/,t-Z L L / 6, t) 1 / --
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):
507- J4 Spring Park, MN Zip: 3 F
Block: Subdivision:
Applicant is: Contractor: 0 Or Owner: ❑
Contractor/Company Name: License #: E400 ? 3
Address: z 22 cam„/ S i'i ' DY- City/State: iA_t- 4QAfZ4< ftA-1 Zip: 3
Telephone: Office/Home: 1�7i - l4 Mobile: ; -
E-mail: Fax: U
Builder/Owner Name: M A-9-K
Address (if diff. from Site):
City/State:
Telephone: Office/Home: Mobile: �P( /Z ) Z.2-1 - 2 �'
E-mail:h'(y S EIZ-vvice eG gea /*7-M 4 « Cow 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 MO?THS OF VALIDATED 9AIL THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS A g-I � ESTED IN g( 9RMANCPWrrH THE STATE BUILDING/ELECTRICAL CODE.
Date: 112 % L 44—
PAYMENT MUST ACCOMPANY APPL/ICATION Be sure to include State Surcharee in payment)
❑ Check attached - Check # _14- �i ?it- 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)
Amount to be withdrawn
Zip Code
L�M�N
OU COMPLY WITH THE *:'CsODE
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Sterne Electric
Sales Receipt
Date
Sale No.
2/2/2022
7544
Payment Method Check No.
Check 14525
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L22-10 - 3701 Sunset Dr
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00