Permits - Permit# L22-24 - 4787 Shoreline Drive - 11/2/2022 CITY OF SPRING PARK OFFICE USE ONLY
Electric Permit# Lz
ELECTRICAL PERMIT z-z�/
Date issued: i Zo zZ Receipt#
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES subrrotal
A. MINIMUM FEE PER INSPECTION TRIP
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per LAM
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 $ 175.00 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
j 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 d..� 1.
Do not forget State Surchar a Fee
You must ca11952-442-7520 when work is ready for inspection!
Describe Proposed Work: Acu rn-b'A F-60 �
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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: -)(; Springy Park, MN Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID(PIN No):
Applicant is: Contractor: Or Owner: ❑
Contractor/Company Name: LZLIK:�� S :U:h�C' License#:.EA6u AcoL4
Address: S City/State: QL- Zip:
Telephone: Office/Home: S Z .jqL- 'j?q 6 Mobile: L__) -
E-mail: o' 0.. v�1 P P.GrC Ci �Ui�oG��_ Fax:
Builder/Owner Name: I..IVLQ�1'1 p �t k� 1 n0ir
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. 1 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. 1 UNDERSTAND THAT THE PERMIT WILL EXPIRE,AND BECOME NULL AND VOID 1F WORK IS NOT
COMPLETED Wn1iTN 12 MONTHS OF VALIDATED DATE AND,THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE STED IN CO 7
ORMAWE -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— / $
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)
M N PE T. Sales Receipt
Date Sale No,
952-A42-7520 F=952-442-7521 M 446-1801
182120"" 7776
Sold To
Laketown Etectic
Payment Method Check No.
Chick 6M40
UesaVion aty Rate Amount
Electrical imyectiowPem itFee-L77 24-4787 ShorelineDr 40.00 40.00
State 3nmba ge-Elacericat L00 1.00
-7
Total S41.00