Permits - Permit# L-1910 - 2471 Black Lake Road - 1/1/2019CITY OF SPRING G PARK OFFICE USE ONLY
ELECTRICAL PERMIT Electric Pe mi # L —1 °I (C>
Date Issued. 6 1 77 / Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DE5CRIPTION OF WORK FEES subaotal
A. MINIMUM FEE PER INSPECTION TRIP
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
r� a
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 ner 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 amp$ 15.00 npr circuit
Transformers up to 10 KVA $ 20.00 each
Transformers over 10 KVA $ 30.00 each
i
—
E. MULTI -FAMILY DWELLINGS
Each dwelling unit $ 50.00 per unit
ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
i
Each System Device or Apparatus @ $ .50 each
WORK BEGUN OR FINISHED WITHOUT;PERMIT IS 2X THE REQUIREDPERMIT.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 call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: powz-r-- +0
l9 �C� p,alC -%*J y{ `/ 64CC4Y� C lAn /-te CL,n n ! Cq
Separate Permits are required for any building, mechanical, fire, or plumbing work.
Poor Quality Document
Disclaimer
The original or copy of a document or page of a document
presented at the time of digital scanning contained within this
digital file may be of substandard quality for viewing, printing or
faxing needs.
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: Z 117aCk lake- RoacK
OR Legal Description: Lot:
Property ID (PIN No):
Applicant is: Contractor: X Or Owner: ❑
Block:
Subdivision:
ip: 55r3 3t(
do"
Contractor/Company Name: 5o4--,, &1e_efy� (, C License #: S4 7 5 —7978
Address: / 7 G 70 r"(e- GAG -& 0-r N t City/State: Pn o,-
Telephone: Office/Home: y( S}' ) 2 3.7- '7 3 8 3 Mobile: (_____j
E-mail: 152CLA @? 5 4-4 el¢C-fy1 C Cor✓1 Fax: ( )
Builder/Owner Name:
Address (if dill. from Site): City/State:
Telephone: Office/Home: Mobile: ()
E-mail: Fax:
Zip: S S 3 -7::Z
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, IF NEEDED (3) THE APPLICABLE CITY APPROVALS, ORDINANCES, AND CODES, AND (4) THE STATE
BUILDINGIELECTRICAL 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.
Signature420
:. �GlLvc Date:
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharlre in Davment
❑ 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
X
V isa/Master Card — S _ ' • () C)
j /Account Number /,, J �7 Expiration Date CSV Amount to be withdrawn
Credit Card Owner Billing Address: I '�f O 7n C �c(J �oOl l i /` �Il� Pi1'b,r j A%GQ_ !rr ? % 1:)"
Street Address City, State r Zip Code
Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
7- MNSPECT,,-.
L---% vs First weer west • Wec-4. ww 553111102
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Sota Electric
Sales Receipt
Date Sale No.
5/16/2019 6686
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - 1,19-10, 2471 Black Lake Rd
State Surcharge - Electrical
80.00
1.00
80.00
1.00
Total $81.00