Permits - Permit# L18-22 - 2425 Black Lake Road - 1/1/2018CITY OF SPRING PARK OFFICE USE ONLY
Electric Per it # L_1 _Zw
ELECTRICAL PERMIT Date Issued: (b Receipt# �ooZ6—
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK
FEES sub/rotas
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
aJ
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 ver 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. FOR INSPECTIONS NOT COVERED ON THIS FORM OR FOR REQUESTED SPECIAL
INSPECTIONS
Hourly charge $ 57.00 per hour
H. COMMERCIAL PLAN REVIEW FEE (IF REQUIRED) is 25% of Total Permit Fee
1. WORK BEGUN OR FINISHED WITHOUT PERMIT IS 2X THE REQUIRED PERMIT FEE
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
Do not forget State Surchar a Fee
Ic�(�
You must ca11952-442-7520 when work is ready for inspection!
Describe Proposed Work: Matra * dttA 7t(,ft,
Separate Permits are required for any building, mechanical, fire, or plumbing work.
IN
PLEASE PRINT OR TYPE
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Job Site: Street Address:
OR Legal Description: Lot:
Property ID (PIN No):
TION AND COMPLETE ITEMS ON BOTH PAGES
UA,V6Q " Spring Park, MN Zip:
Block: Subdivision:
Applicant is: Contractor: P( Or Owner: ❑
Contractor/Company Name: r l a t=_ License #: 4ne-1,�/
Address: 1 o (05 O Co Lt,',!�:j P cl 8 � S iC- P City/State: M uj? l.P �. Zip: SS 3 o9
Telephone: Office/Home: (-?UZ '-iZti - L4 3 Z) Mobile: lo( � 2 ) Z$ Z - Ci" t> J
E-mail: C�P_✓1 SQ 14' (j P C;i rl,�. to r NL4 �, , Lom Fax: w3 Zo - 27`{Z
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Builder/Owner Name: Je SS i e- r 0ai—k: C h c-S c,
Address (if diff. from Site):
Telephone: Office/Home: (,
E-mail:
City/State: Zip:
Mobile: (�
Fax: ()
I HEREBY APPLY FOR AN ELECTRICAL PERMIT, AND 1 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 REQUIRED
INSPECTIONS ARE REQUESTED IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Signature:
Date: 9/01ala
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in ipavment)
❑ 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
jilr Visa/Master Card -Aft_ $
Account Number Expiration Date CSV Amount to ge withdrawn
Credit Card Owner Billing Address: / p(ajlo Co"/%�-1 Q3 Y) S j r�n 0.pU S53 toyj
fStreet Addre s City, State Zip Code
Payment Aidhorization Signature (REQUIRED) Print Naludon credit card (REQUIRED)
J' MNSPECTLLC
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Pride Electric
Sales Receipt
Date
Sale No.
10/4/2018
6025
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L18-22, 2425 Black Lk Rd
State Surcharge - Electrical
125.00
1.00
125.00
1.00
Total $126.00