Electrical Permit - Permit# L 22-16 - 4177 Shoreline Drive - 5/10/2022 (0110EUSFONLY
cirri, OF SPRING PARK Electric Pernyt# L.
FLECTRICAL PERMIT Dole kslwd: -5#btzl 'Rmeipl M
PRINT 011111"PE AIA, INFORNIA'I'ION AND COMPLETE ITEMS ON BOTtl PAGES
FEES Subrrotal
DESCRIPTION OF WORK
A. MINIMUM FEE PER INSPECTION TRIP
111CILidel, Lip to 4 circuits if more than .1 see Sec. D below $40.00-1 per
Additional inspection trips for Reins poctim i/13o rid in 9/E(I u ipote ntia I Plano/etc. $ 40.00 per
B. RESIDENTIAL One and Two-family dwelling units Up to 3 trips Included In fee
1. Now Dwelling Unit, LIP I to and including a 200 amp service $ 125.00 per unit
2. Now Dwelling Unit, 201 amp to 400 amp service $ 175.00 per unit
amp service,
a
3. Existing Dwelling Unit, additions, alterations, or repairs up to & including a 20 $ 125.00 per unit__
fees as per C & D-below-but not to exceed rvice
4.-"Existing dwelling Unit, additions, alterations, or repairs 201 amp to 400 amp se
foes as per C & D below but not to exceed ---I -$—!'T X per unit
5. New orExisting 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 FEEDE&;5TO
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 $200.00 each
4, 801 amp service and above $ 300.00 each
D. FEES FOR CIRCUITSIFEEDERS &TRANSFORMERS
-
$1 0.90-per circuit
0 to 200 amp
Above 200 anip $ 15.00 per circuit
Transformers up to 10 KVA $ 20.00 each
$ 30.00 each
Transformers over 10 KVA
E. MULTI-FAMILY DWELLIN
$ 50.00 per unit
Each dwelling unlit
ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
$ .50 each
Each Svstem Device or Apparatus
--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
(Do not forget State Surcharge Fee)
You 7520 when work is ready for inspection!
Describe Proposed Work: *1
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. O.')-{ 2 �o(e k1 Spring Park, MN` Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No).
Applicant is: Contractor: k5 Or Owner: El
Contractor/Company Name: License#: 6 L b
Address: [`�0`S S City/State: lA ti Zip: S S 34.7
Telephone: Office/Home: ( )_-_ Mobile: �j( q ) �E - , 3 q o
E-mail: Fax: (— )
Builder/Owner Name: SAT �1-1 f(o,o.r h'r(J
Address (if diff. from Site): City/State: Zip:
Telephone: Office/Home: (_WL ) $ $ Mobile:
E-mail: Fax:
I IiEREBY APPLY FOR AN ELECTRICAL PERMIT,AND I ACKNOWLEDGE THAT T14E 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.1'ERFORMED ACCORDING TO THE FOLLOWING:(1)THE CONDITIONS OF THE PERMIT,(2)THE APPROVED
PLANS AND SI'ECIFI CATIONS,IF NEEDED(3)THE APPLICABLE CITY APPROVALS,ORDINANCES,AND CODES,AND(4)'THE STATE
BUILDING/I:LECT'RICAL CODE. I UNDERSTAND THAT THE PERMIT WILL EXPIRE,AND BECOME NULL AND VOID IF WORK IS NOT
COMPLETED WITiIIN 12 MONI'IIS OF VALIDATED DATE AND;TI]AT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE RF.OU .TED IN C NFORMANCE WITH THE STATE BUILDINGIELECTRICAL CODE.
Signature: -� Date: 12--
PAYMENTMUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in payment)
Cl Check attached—Check It MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@}u mnspect.COM
FAX: 952-442-7521
MAJUDELIVER: MNS'PECT,235 West First Street Waconia,MN 55387
Visa/Master Card— _ A,, �. — $
Account Number( ! Expiration Date CSV Amount tobe withdrawn
Credit Card Owner Bill' g Address: i 7 U 3; L O'A—, __ �O LA k4✓1',. H Al `1 7 D J
Street Address City,State Zip Code
Pa me t Aut ortzation Signature(REQUIRED) Print Name on credit card(REQUIRED)
M NSPECTLLC Sales Receipt
L Date Sale No.
952-442-7520 Fax 952-442-7521 888-446-1801
5/10/2022 7634
Sold To
Westys Electric
Payment Method Check No.
MasterCard
Description Qty Rate Amount
Electrical Inspection/Permit Fee-L22-16-4177 Shoreline Dr,Unit 80.00 80.00
206
Electrical Inspection/Permit Fee-L22-17-4177 Shoreline Dr,Unit 80.00 80.00
103
State Surcharge-Electrical 2 1.00 2.00
Total $162.00