Electrical Permit - Permit# L22-12 - 2258 Hazeldell Avenue - 2/14/2022** IN30UND NOTIFICATION : FAX RECEIVED SUCCESSFULLY ""
TIME RECEIVED REMOTE CSID DURATION PAGES STATUS
February 11, 2022 at 3:19:47 PM CST 70 2 Received
Feb. 11, 2022 2:59P 1 Electric City Corn No.4236 P. 1
CITY OF SPRING PARK OFFiceusaoNt.v
Electric Per if # �L L2 -(I--
ELECTRICAL PERMIT Dale Tssued: ! Zv Receipi H
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES sub/Total
f MUM,EEE RF,j INl$F �'I ION `TRIO
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
Additional Inspection trips For Relnspection/Bonding/Equipotential Plane/etc. $ 40.00 per
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i36.-I,fT,IAL ; ,Qno=�ttd Twmtnf[y digtiyb�lu_hlts
— —
1. New Dwellino Unit, u to and including a 200 am service t 125.00 nor 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 3 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
5. New or Existing Dwelling Unit, 401 amp service or above See C ZI 0 below
'
FE PCR=I�t�QR UP RAD.;S�11/[ s, TSM:P�VIIS,�Q�FTOt� a ;
OTH P_ ..IifEii-S.UP_ .ti - G
1. Up to and including a 200 amp service 50.00 each
2.201 amp to and Includin 400 am service $ 100.00 ea h
3.401 amp to and including 800 amp service 200.00 each
4. 801 am service and above $ 300,00 each
_
D. FHE wri RtrUlt-S# ahRSAF-TKAN§PORMEFt�_ ,j -; .. i, =
0 to 200 am 10, 00 Per circuit
Above 2 0 amp I 15,00 er circuit
Transformers up to-10
Transformers over 10 KVA
_ 'T(F�4�tfLY„„171fItELI•INC� �-_ �- ' max � s i _ z {
Each dwelling unit $ 50.00per unit
Al..AR .011111MUNfCdTI.ON, StONALIN04IRG1It(1 .., FLEA$ THA:�I; Q VC1LT3
Each S stem Device or Apparatus $ .50 eachlZME
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DU tR f6.
:li _Q1fi(Jtlt� P�RiTar__
State surcharge .0006 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DU
Do not for et State Surahar a Fevi�qll
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You must cal,l„952-442-7520 when work is ready for inspection!
Describe Proposed Work:, ff2i, WIA
�J; �► '' 091 tV0 11J17
Separate Permits are required for any building, mechanical, fire, or plumbing work.
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Feb.11. 2022 3:OOPM Electric City Corp
No.4236 P. 2
PLEASE PRINT OR TYPE ALL INFORMATION" AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: A, :z c � { l Spring Park, MN Zip: 55 38
OR Legal Description: Lot:
Property ID (PIN No):
Block: Subdivision:
Applicant is: Contractor: bl Or Owner: 0
Contractor/Company Name: _4 trp A�-� Q L�Gc. License #: k-
Address: 23 0 �a/ t�r,� City/State: ` Lo.nl cr1.i11Y1J Zip:
Telephone:
Office/Home: ( -)
2L
- Iola ()!5� Mobile:
E-Mail:
N �L �-�'�[v1�—!
.; j C�� � �J . � �/l Fax:
Builder/Owner .Name,
9k 4/� k"
Address (if diff. fi-om Site): � City/State: Zip:
Telephone: Office/Home: (S } � - Mobile:(_--) -
E-mail: Pax: ( -
I HW8Y APPLY FOR AN BLWIRICAL PERMIT, AND I ACKNOWLEDGE THAT THE INPORMA?ION ABOVE IS COMPLETE AND ACCURATE, I
UNDERSTAND WORK IS NOT TO START WITHOUT A PFRM[T, I UNDERSTAND AND HEREBY AGREE THAT THE WORK FOR WWCH THE
PERMIT IS ISSURD SHALL BI3 PERFORMED ACCORDING TO THE FOLLOWING: (1) THE CONDITIONS OF TM PERMIT, (2) THB APPROVAD
PLANS AND SPECIFICATIONS, IF NEEDED (3) THE APPLICABLE CITY APPROVALS, ORDINANCES, AND CODES, AND (4) THE STATE
BLMMING/BLBCTRICAL CODE, I MI AND THAT THE PERT WILL EXPIRE, AND BECOME NULL AND VOID IF WORK 13 NOT
COMPI.EM WITHIN I NIOMTiS VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS TED 'OORMANCB )VITH THB STATE BMLDINO/ELBCTRICAL CODE:
Signatt -e: Date: ' It -
❑ Check attached— Check #
MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspectcom
FAX: 952-442-7521
MAIL/DWUR: MNSPECT, 235 WestFicst Street Waconia, MN 55387
Xri 'Visa/MCaster Card — _ $ `/ 1. 0 0.
AccountNumber Expiration Date CSSV Amount to be withdmvn
Credit Card Owner Billing Address: 'S 2-) 0 t74/ ti^ } L �,� it- /A'i --- ` d (
StreetAddress City, State Zip Cod*
( � old - C /,3,
PA e t t hation Si nature (REQUIRED)
V
! 0AC
Print Nftme on credit caret (REQUIRED)
[;�MNSPECTLLC
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Electric City
Sales Receipt
Date
Sale No.
2/14/2022
7556
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L22-12 - 2258 Hazeldell Ave
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00