Permits - Permit# L16-022 - 2425 Black Lake Road - 1/1/2016CITY OF SPRING PARK OFFICE USE Y
ELECTRICAL PERMIT Electric Permit # L 0 �
Date Issucd-q61 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
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
. 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 $ 57.00 per hour
. COMMERCIAL PLAN REVIEW FEE (IF REQUIRED) is 25% of Total Permit Fee
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 o0
You must ca11952-442-7520 when work is ready for inspection!
Describe Proposed Work:
No (
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: N Z::l aC h � VoVV A. .Spring Park, MN Zip:553
OR Legal Description: Lot: Block:
Property ID (PIN No):
Applicant is: Contractor: 4 Or Owner: ❑
Contractor/Company Name;
Subdivision:
License #: to
Address?j41 C-Q&y A V m a SQ - City/State: NI Mne pol l S N O zip: _
Telephone: Office/Home: -72-1 - Mobile:
E-mail: CkM\l e pa�wsQAwy 1( ( (1(,- co VVl Fax: 4 2 All - -1--t_ S
Builder/Owner Name::i_u ►o,hwle
Address (if diff. from Site):
City/State:
Telephone: Office/Home: l l U l) 1- Mobile: U
E-mail:
Fax:
Zip:
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, ff 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 MONTIJS OF VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS STE CONFORMAN WITH THE WITHE STATE BUILDING/ELECTRICAL CODE.
Signature: Date: ll�
PAYMENT MUSTACCOMPANY APPLICATION (Be sure to include State Surcharee in Davment)
1� Check attached - Check # ��j1 O 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 -
Routing Number Account Number
Payment Authorization Signature (REQUIRED)
❑ Visa/Master Card -
Credit Card Owner Billing Address:
Account Number
Street Address
Amount to be withdrawn
Print Name on account (REQUIRED)
Expiration Date Amount to he withdrawn
City, State
Zip Code
Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
MNSPECTLL.
- I]! F— -- W— • We 1-, MN WO-01
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Brothers Electric
Sales Receipt
Date
Sale No.
8/25/2016
4205
Payment Method Check No.
Check 34510
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L16-022
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00