Permits - Permit# L20-02 - 2429 Black Lake Road - 1/1/2020R
CITY OF SPRING PARK OFFICE USE ONLY
ELECTRICAL PERMIT Electric Per�it # L -�L-
Date Issued: I l Z e Receipt # 01�
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
yp
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 am to and including 400 amp service $ 100.00 each
401 amp to and including 800 amp.service $ 200.00 each
.,3./
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. 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)
$1/ 60
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work:
Separate Permits are required for any building, mechanical, fire, or plumbing work.
..
''.-----PLEASE PRINT OR TYPE ALL INFORMATION AND
ITEMS ON BOTH PAGES
Job Site: Street Address:
OR Legal Description: Lot:
Property ID (PIN No):
Block:
Applicant is: Contractor: Or Owner: ❑
_
Spring Park, MN Zip: IST191
Subdivision:
Contractor/Company Name: VV1 Y)'��1.5 �1 Qr�(Y (\�- License
� City/State: Zip /S
Address: "S� s � � Mtkp
Telephone: Office/Home: DS�KPMobile: l)_?�3 - qla r
E-mail:�e.t�lt1�'1►M�)S��eL�('tC.. Y�P�� Fax: �) -
Builder/Owner Name: saex r Q, &A I( . CU I v 1-1-n
-Adc3'ress (if diff. from Site): City/State: Zip:
Telephone: Office/Home: (Wa _7 ! - - Q t, Mobile: U -
E-mail:
Fax:
I HEREBY APPLY FOR AN ELECTRICAL PERMIT, AND I ACKNOWLEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND ACCURATE; 1
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 WI 12 MONTHS OF VALID TED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS REQUESTED IN CON FO ANCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Y.1. ;�1,'�
ipxi) e: 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 —
Credit Card Owner Billing Address:
Account Number
Street Address
Payment Authorization Signature (REQUIRED)
Expiration Date CSV
City, State
Print Name on credit card (REQUIRED)
Amount to be withdrawn
Zip Code
J' MNSPECT.
--� � �JS Fiifl 3lresl Weak • We�onia. MN 6513)-1303
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Tommy's Electric
Sales Receipt
Date Sale No.
3/19/2020 6947
Payment Method Check No.
Check 6424
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L20-02, 2429 Black Lake Rd
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00