Permits - Electrical Permit# L22-24 - 4216 West Arm Drive - 10/31/2022 CITY OF SPRING PARK OFFICE USE ONLY
ELECTRICAL PERMIT Electric Permit# L?-z.-z V
Date Issued: to ?1 ZZ 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 40
Additional Inspection trips for Rein spection/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 er 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 aTR to and including 400 amp service $ 100.00 each
3.401 amp to and including 800 amp service $200.00 each
4. 801 am service and above $ 300.00 each
D. FEES FOR CIRCUITSIFEEDERS&TRANSFORMERS
0 to 200 am $ 10.00 per circuit
Above 200 am It 15.00 er 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. FOR INSPECTIONS NOT COVERED ON THIS FORM OR FOR REQUESTED SPECIAL
INSPECTIONS
Hourly charge
57.06 per ho
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State Surcharge .0005 of the permit fee(minimum of$1.00) 1.00
41
:etTStatOTAL AMOUNT DUE
Do not for e Surchar a Fee
You must call 952-442-7520 when work is ready for inspection
Describe Proposed Work: FIREPLACE
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: 4216 WEST ARM DR Spring Park, MN Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor: tsC1 Or Owner: ❑
Contractor/Company Name:SUBURBAN ELECTRIC License#: EA677535
Address:PO BOX 188 LORETTO, MN 55357 City/State: Zi
P:
Telephone: Office/Home: (7 498 _ 7215 Mobile: (_)
E-mail:JESSICA@SUBELECT.COM
Fax: ( ) _
Builder/Owner Name:
Address (if diff. from Site): City/State: Zip:
Telephone: Office/Home: ( � - Mobile: ( )
E-mail: Fax:
1 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, 1 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 AL.I,REQUIRED
INSPECTIONS ARE REQUESTED IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Signature: JESSICA ANFINSON Date: 10/31/22
PAYMENT MUST ACCOMPANY APPLICATION(Be sure to include State Surcharge in Dayment)
❑ Check attached—Check# MAKE CHECKS PAYABLE to MNSPECT
MAIL: MNSPECT, P.O. Box 342, Waconia, MN 55387
FAX: 952-442-7521
DELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
❑ E-Check— _ g
Routing Number Account Number Amount to be withdrawn
Payment Authorization Signature(REQUIRED) Print Name on account(REQUIRED)
❑ Visa/Master Card— SEE COVER LETTER / $
Account Number Expiration Date Amount to be withdrawn
Credit Card Owner Billing Address:
Street Address Ciry,State Zip Codc
JESSICA ANFINSON JESSICA ANFINSON
Payment Authorization Signature(REQUIRED) Print Name on credit card(REQUIRED)
M NSPECT��� Sales Receipt
O:�Q
Date Sale No.
952-442-7520 Fax 952-442-7521 888-446-1801
11/3/2022 7784
Sold To
Suburban Electric
Payment Method Check No.
Visa
Description Qty Rate Amount
Electrical Inspection/Permit Fee-L22-24-4216 West Arm Dr 40.00 40.00
State Surcharge-Electrical 1.00 1.00
Total $41.00