Electrical Permit - Permit# L 22-17 - 4177 Shoreline Drive - 5/10/2022 CITY OF SPRING PARK OFFICE USE ONLY
Electric PeyTiIpt# L Z -
ELECTRICAL PERMIT Date Issued: � d c� R-cip ##
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
1 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
r
s as er C & D below but not to exceed 175.00 er unit
w or Existing Dwelling Unit, 401 amp service or above See C &D below
S FOR NEW OR UPGRADED SERVICES,TEMP.SERVICES, GENERATORS,
ER POWER SUPPLY SOURCES OR FEEDERS TO SEP.STRUCTURES
to and includinga 200 am 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 amp—-_ $ 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
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 Surchar a Fee
You must ca11952-442-7520 when work is ready for inspection!
Describe Proposed Work: �� � ►j B?�n/ 4
10 c,� e.t
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 l p y 7 S lac�,K (�, Spring Park, MN Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor: 25 Or Owner: ❑
A
Contractor/Company Name: We License#:
Address: B 0 '1 5 Cor City/State: LUG c c�"i r, /L4 rk Zip:_E 3 F?
Telephone: Office/Home: ( ) - Mobile: bt( 2 ) 71 E - 3 90
E-mail:_ /�< ys Fax: ( )
Builder/Owner Name:
Address(if diff.,from Site): City/State: Zip:
Telephone: Office/Home: (_ ) - Mobile:
E-mail: 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 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 REQUEST IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Signature: Date:
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— St, 4 5 6 F+v r / $
Account Number Expiration Date CSV Amount to be withdrawn
Credit Card owner Billing Address:
Street Address City,State Zip Code
Payment Authorization Signature(REQUIRED) Print Name on credit card(REQUIRED)