Permits - Permit# L21-14 - 4146 Shoreline Drive - 4/7/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Permit # L Zc -ref
Date Issued: _V7 z t Receipt #
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
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
_
0to200am _P— -__ _ $ 10.00 per circuit
Above 200 amp $ 15.00 eer 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)__ i.��,
You must call 952-442-7520 when work is ready for insuection!
Jl, a \o n /Z - - A _�'..
Describe Proposed Work:
Separate Permits are required for any building, mechanical, fire, or plumbing work.
n I
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address:
Spring Park, MN Zip: 2)
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor: Or Owner: ❑
��tl
Contractor/Company Name: ✓� License #:���C
Address: 1 City/State: ,� Zip-55
Telephone: Office/Home: �Mobile: �) -
E-mail rA R �'�� I Fax: -1 -
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 Q D
INSPECTIONS ARE REQUESTED IN CONFORMANCE WITH TI " STATE BUILDING/ELECTRICAL CODE.
Signature: —� Date:
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharee 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 Waconi4, MN 55387
Visa/Master Card — _ . $ Mco
Account Number Expiration Date CSV Amount to be withdrawn
Cr •dit Card Owner Billing Address; (P . ct cyl � lU W 11 1SC.1��1 N► p � �(
StrZip Code eet Address 'ity, State t �✓" \
A�]Av I I � 1 II
Paymen A orization Signa re (R . D) Print Nam on credit card (REQUIRED)
MNSPECTLLC
-- �---- 335 First Street West • Weconle, MN 55]B]-1302
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Xtreme Electric
Sales Receipt
Date
Sale No.
4/7/2021
7288
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - 1-21-14, 4146 Shoreline Dr
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00