Electrical Permit - Permit# L 21-12 - 2424 Black Lake Road - 4/2/2021CITY OF SPRING PARK 0)rr1cF USI;ONLY
Electric P rm't # L
ELECTRICAL PERMIT Date sIlvi �li� Receipt
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
Additional Inspection trips for Reinspection/Bonding/Equipotential Plane/etc. $ 40.00 per
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--- 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
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1. Up_to and includinga 200 amp service $ 50.00 each
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2. 201 amp to and including 400 amp service $ 100.00 each
3. 401 amp to and includin�800 amp service $ 200.00 each
4.801 amp service and above _ $ 300.00 each
D. FEES FOR CIRCUITS/FEEDERS & TRANSFORMERS
0 to 200 amp $ 10 00 per circuit
Above 200 am $ 15.00 per circuit
Transformers into 10 KVA $ 20.00 each _
Transformers over 10 KVA $ 30.00 each
_
E. MULTI -FAMILY DWELLINGS
_
Each dwelling unit $ 50.00 per unit
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. 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
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—._ _.
State Surcharge .0005 of the permit fee (minimum of $1.00)
TOTAL AMOUNT DUE
(Do not forget State Surcharge Fee
1.00
11V"
You must call 952-442-7520 when work is ready for inspection_!
Describe Proposed Work: tom-' + /—, 5 / ^' 34c `',%r
Separate Permits are required for any building, mechanical, fire, or plumbing work.
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: Z 412— bldc_k Z /c )2 D Spring Park_ MN Zip:
OR Legal Description: Lot:
Property ID (PIN No):
Applicant is: Contractor: IX Or Owner: ❑
Block:
Subdivision:
Contractor/Company Name: WSJ 17 M C/CZnT✓-/Q License 0:64 -k)2 Z 3 %
Address: S _(U% S r ✓C jU y✓ City/State: N Zip: 57s3�/
Telephone: Office/Home: ��) - Mobile: CIX 7 -
E-mail: L `� 7TS CLCc-'TK.Jc. /0" / �. Fax:
I Builder/Owner Name:
/CA^
Address (if diff fi-om Site): � �City/State:
Telephone: Office/Home: (� } _______ -
I E-mail:
Mobile: (
Fax:
Zip:
I HF:RI1iY APPLY FOR AN 11,FCIRTCAL PIiRMI1', AND I ACKNOWLE[XiEl'i [A F H IT INFORMATION ABOVE IS COMPLETI'_ ANT) ACCURA113: I
UNDi.RSTAND WORK IS N01" r0 S'rART' WI`FHOUr A PERMIT I UNDERSTAND AND H RIMY AGREE THAT TFIF. WORK FOR W11101 'I'll]:
Pf'.RMI'1 FS ISSI II'D SHAI.I. IiF PFdtFi)RMl",F) ACCt)IZD1N(; "I O "I HF. Pt)1. LOWINti: (1) Ti l}? CONDrI'IONS OF'NIF PFRMIT, (2) TFIE APPR0VED
PLANS AND SPECIFICATIONS, IP NLL'DID (3)111F APPLICABLI CFFY APPROVALS; ORDINANCI>3. AND CODG;S, AND (4) H IF S'FA'I'F
101ILDINO/FLECT' 7Ii. I UNDERS"I'AND THAT TIII P1. RMIr WILL EXPIRE. ANT)13SCOMIS NUL[, AND VOID IF' WORK IS NO'F
C'OV1P1.1; 1 Elytl41111IN i2 Mol� OF VALIDA11 D DATE 1ND, T'IIA1' I AM Rl SPONSIB F FOR ENSURING - H A'F ALL REQUIRIiD
INSPI:C'1'I(tl�, ARE RI.t)I IFS' T C7iR1Et)RI�LANCI; W1TH t H1: S'CAl'li f3U11 1)INGA`L1,C I'RICAL CODE.
Signature: '�____ t _ -'' . /
Date:"
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in payment
❑ Check attached — Clieck # MAKE CHECKS PAYABLE to MNSPECT
EMAIL: clecti-ical@nitispect.com
FAX: 952-442-7521
MAIL/DELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
❑ Visa/Master Card —
Credit Card Owncr Billing Address,
Account Number Uxpirttion Date
street Address
Payment Authorization Signature (REQUIRED)
CSV Amount to be tuithdrawn
Print Name on credit card (REQUIRED)
Zip Code
MNS
�oM- �ooE
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Watts Electric
Sales Receipt
Date
Sale No.
4/2/2021
7278
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - 1-21-12, 2424 Black Lake Rd
State Surcharge - Electrical
125.00
1.00
125.00
1.00
Total $126.00