Electrical Permit - Permit# L21-15 - 4527 Shoreline Drive - 4/15/2021CITY OF SPRING PARK OFFICE USE ONLY _
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ctric Perm't # L e / "/�
ELECTRICAL PERMIT 0�aj Rcccipt
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
Al D
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
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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 oer circuit
3D'
Above 200 amp $ 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
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
You must ca11952-442-7520 when work is ready for inspection!
Describe\ Proposed Work:-\J�Q\\
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Separate Permits are required for any building, mechanical, fire, or plumbing work.
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PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: J 52.'I S�Nba_\'�\e. ( • Wiring Park, MN Zip: SS 3
OR Legal Description: Lot:
Property ID (PIN No):
Block: Subdivision:
Applicant is: Contractor: 19 Or Owner: ❑
Contractor/Company Name: 5ER-D E-.,\QK \C,-1t"C ` License #: E-No10 0
Address: ��� iT\ �� "�A N� City/State: ���\e`� , M tV Zip: 5S 3 Z
Telephone: Office/Home:( �3 ) �S1 - 1_ Mobile:(
E-mail: O.C� O��tiq @ sez a 2C�T �Ca CO Fax:
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 ACKNO\l'LEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND ACCURATE: I
UNDERSTAND 'v\'ORK 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 PER\III', (2) THE APPROVED
PLANS AND SPECIFICATIONS. IF NEEDED () THE APPLICABLE CITY APPROVALS, ORDINANCES, AND CODES, AND (4) THE STATE
BUILDING ELECTRICAL COD I UNDERSTAND THAT THE PERMIT FILL EXPIRE. AND BECOME NULL AND VOID IF «'ORK IS NOT
COMPLETED WITHIN' 12 S OF VALID DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE REQ LLD N CONF \ ; CE WITH THE STATE BUILDIN&ELEC'TRICAL CODE.
Signature: xi.. Date:
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharhe in payment)
- Check attached — Check # MAKE CHECKS PAYABLE to MNSPECT
EMAIL: cicctricalCmnspect.com
FAX: 95 2-442-7 521
MAIL/DELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
Visa/Master Card —_, S 'A\
Expiration Date �`� M w\CS\ Am<ounnt ttoo he withdrawn
Credit Card Owi ilin@ Address: �v ` ` „\ lV� � \� g , vim' v" `�-L
Street Address-- City. State Zip Code
Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
MNSPECT,,.
------1J5 Frrsl Slreel West • Weconie. MN SSJB I130t
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
SECO Electric
Sales Receipt
Date
Sale No.
4/15/2021
7291
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-15, 4527 Shoreline Dr
State Surcharge - Electrical
70.00
1.00
70.00
1.00
Total $71.00