Electrical Permit - Permit# L22-22 - 4022 Sunset Drive - 9/6/2022 CITY OF SPRING PARK OFFICE USE ONLY
ELECTRICAL PERMIT Electric Permit# L Zip Date Issued: IZ ZL #Receipt _
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES Sub/Total
A. 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 serv'we $ 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
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
C. FEES FOR NEW OR UPGRADED SERVICES, TEMP. SERVICES, GENERATORS,
OTHER POWER SUPPLY SOURCES OR FEEDERS TO SEP. STRUCTURES
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 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 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
G.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 must ca11952-442-7520 when work is ready for inspection!
Describe Proposed Work: t/ & Oct C-- + C4 (C' Y
-eA
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: Spring Park, MN Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor Or Owner: F
Contractor/Company Name: 15A� �,(/-K (,Q,�Y 1[, License#. 20
Address:( On 140 S • City/State: Aif elw_v Zip:
Telephone: Office/Home: )
E-mail: //yy �� Fax: ( ) -
Builder(5)r Name:
Address(if diff. from Site): City/State: Zip:
Telephone: Office/Home: (OZI )_7 5 1 Mobile:
E-mail: Fax: O -
I HEREBY APPLY FOR AN ELECTRICAL PERMIT,AND 1 ACKNOWLEDGE THAT THE INFORMATION ABOVE 1S COMPLETE AND ACCURATE;I
UNDERSTAND WORK 1S 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 QUES IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE. r�
ch
Signature: Date: 0 5 2
PAYMENT MUST ACCOMPe7:APPI ICATION(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— / $
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)
=SPE Sales Receipt
QDD Q
Date Sale No.
952-442-7520 Fax 952-442-7521 888-446-1801
8/25/2022 7714
Sold To
Spark Electric
Payment Method Check No.
Check 73233
Description Qty Rate Amount
Electrical Inspection/Permit Fee-L22-22-4022 Sunset Dr 40.00 40.00
State Surcharge-Electrical 1.00 1.00
Total $41.00