Electrical Permit - Permit# L22-21 - 3960 Sunset Drive - 8/10/2022 CITY OF SPRING PARK -- OFFICE LIM ONLY
ELECTRICAL PERMIT Electric Permit# L Zz---L I .,.r..
Date Issued: 31f Zc— Receipt II
PLEASE PRINT OR TYPE ALL, INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES SubrTatal
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.O�er 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 per unit
5. New or Existing Dwelling Unit,401 amp service or above See C& D below
. FEES FOR NEW OR UPGRADED SERVICES, TEMP.SERVICES, GENERATORS,
OTHER POWER SUPPLY SOURCES OR FEEDERS TO SEP. STRUCTURES
1. U to and including a 200 amp service i $ 50.00 each s"4,
2. 201 amp to and including 400 amp service $ 100.00 each
3.401 am 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 Der 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
F.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 for et State Surcharge Fee
You must call 952-442-7520 when work is ready for inspection!
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Describe Proposed Work: ��►S�`1��`t a �`�� «� �� � �
Separate Permits are required for any building, mechanical,fire,or plumbing work.
ZZ ' —pa�Z�
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE. ITEMS ON BOTH PAGES
Job Site: Street Address: 3 I�() St -J`e-1 P''A e Spring Park, MN Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID(PIN No):
Applicant is: Contractor:/IQ Or Owner: ❑
Contractor/Company Name: likklt:� 110 c License#• L—�A7el,775
Address: I�D �,t/�C,jh�(�i �in City/State: //1/J/!/ Zip: 537 7�
Telephone: Office/Home: Mobile: ( /_-) ) -7y/ - oF'7yy
E-mail: d>✓" �So%c><<�� X_yrn w��. ed M Fax:
Builder/Owner Name:
Address(if diff. from Site): City/State: Zip:
Telephone: Office/Home: Mobile: d( I ) 3 i5—_ SS��
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 A:&=
RENCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Signature:
Date: &7/Z z
PAYMENT MUST ACCOMPANY APPLICATION(Be sure to include State Surcharge in oavment)
❑ 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 {—
Vis Master Card _ $� 7
Acco�t7 p ___. .. p.ation Date `CSV Amount to be
withdrawn
Crcdit Card Billing Address: It1 � 1 V"yj4e3� V"• A/ ' M Al, S 3 7/
Street Address City,S to Zip Code
QiAf-1 -7-DaV
Pay ent Authorization Signature(REQUIRED) Print Name on credit card(REQUIRED)
s
\ " M N S P E C TLLC Sales Receipt
J
__J Date Sale No.
952-442-7520 Fax 952-442-7521 888-446-1801
8/10/2022 7701
Sold To
Lake State Electric
Payment Method Check No.
MasterCard
Description Qty Rate Amount
Electrical Inspection/Permit Fee-L22-21 -3960 Sunset Dr 50.00 50.00
State Surcharge-Electrical 1.00 1.00
Total $51.00