Electrical Permit - Permit# L21-16 - 4434 West Arm Road - 4/21/2021CTTY OF SPRING PARK
ELECTRICAL PERMIT
OMCE USE ONZY
Electric P' /e}-x�it # L � (- ( b
Date Issued: 7 %`�/Z� Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION 'Of WORK fEES subrrotai
:`MIN[RA J`1CA FEE'PER INSf*ECTIONTRIix
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 $ 12,5.00 per unit'
i27
4. Existing Dwelling ,Unit, additions, alt-eratEo.ns, orrrepairs 2,01 arnp.to 400 amp service
fees as per C & D below but not to exceed 175.00 Der unit
5. New or Existing Dwelling Unit, 401 amp service or above See C & D below
C.TEE.S FOR NEW -.OR UPGRADED SERVICES, TEMP. SERVICES, GENERATORS,
OTHER POVNER 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
3. 401 amp to, and includinn 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.GG each
_
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Each dwelling unit $ 50.00 per unit
F. ALARM, CO MMUMCATION; SlONALING VROU1TS, OF'LESS-THAIt 50'VOLTS
Each System Device or Apparatus @ $ .50 each
,IIVD(;2K BEGU[J OR,FINLSHED IN(Tt{OUT PEf�MtT tS 2�CTIiE,REQUiRED PERII(!IT f'EEf ,� r
:`
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
i
TOTAL AMOUNT DUE
(Do not forget State Surcharge Fee
J$. �1
You must ca11952-442-7520 when work is ready for inspection! l�v✓�
Describe Proposed Work: k 6 "( 4r-v 9-- ( I P.-(it '' I Vlp R-1- tw-e-I pz�e-J
Sob "
Separate Permits are required for any building, mechanical, fire, or plumbing work,
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PLEASE PRINT OR TYPE ALL INFORMATION ANI) COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: qff 3 q W e,-�d- LOA �•c� Spring Park, MN Zip: S-Sr38
OR Legal Description: Lot:
Property ID (PIN No):
Block:
Subdivision:
Applicant is: Contractor: x Or Owner: ❑
ContractorXompanyName�_` C FrC _ l vt G License #r L f� 72 92
Address.: 'j 7 t 9qh�i Je iJ City/State: UOeHo, j"I? I J Zip: 5-5-35—`7
Telephone: Office/Home: (9 Mobile:
E-mail: �% i L- �' Gem f f - Gr�� Pax: () -
Bnilder9Owner Name: �` 2 S�/�j �M
Address (if diff, from Site): Z %5- i+64,t. 5" 4"t 9 � City/State: r � jjA1oP115, r'/r' Zip: 537Yy-1—
Telephone: Office/Home: ( ( Q ) 3e45- - �'N Mobile:( -
E-mail: �tav YILYi,.e S Pax: (� -
I HEREBY APPLY FOR AN ELECTRICAL PERMIT, AND ACKNOWLEDGE THAT THE 12'IFOR-MATION ABOVE IS COMPLETE AND ACCURATE; I
LNDtRSTANIY WORK is NOT TO STAlkT WITHOUTA PER�-v1IT. I UJNDI`-RSTAND AND HEREBY AGREE THAT THE WORK FOk 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 MO S OF VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE RE D IN CONFORMANCE WITH THE STATE-BUILDING/ELECTRICAL CODE. 9I
Ci anafiira Date:: Y/`( /-e/
❑ Check attached — Check #
MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspect.com
FAX: 952-442-7521
MAIIJDELIVER: MNSPECT, 235 West First Street-Waconia, MAT 55387
❑ Vi.sa/Master Card —
Credit Card Owner Billing Address:
Accoum Number
Street Address
Payment Authorization Signature (REQUIRED)
(ZL
uxpwanuon iJaUC (J V Anta= to be witbdrawn
City, State
Print Name on credit card (REQUIRED)
Zip Code
MNS
" F �aoE
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
LP Electric
Sales Receipt
Date
Sale No.
4/21 /2021
7300
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - 1,21-16, 4434 West ARm Rd
State Surcharge - Electrical
125.00
1.00
125.00
1.00
Total $126.00