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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)