Electrical Permit - Permit# L 21-09 - 4177 Shoreline Drive - 3/18/2021RECEIVED MAR 18 2021
CITY OF SPRING PARK OFFICE USE ONLY
ELECTRICAL PERMIT Electric P r it # L 2 t -off
Date Issued: 3 � Zt Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES suwotal
A. MINIMUM FEE PER INSPECTION TRIP
2
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
OL 8'V
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
L—
. 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 a p ryice _ $ 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 amp $ 10.00 per circuit
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
. ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ $ .50 each
.;WORK BEGUN, Ott,FINIS14ED WITHOUT PERFAIT I$U THE REQiIIRED PERIL f;;FEE . W x ;
, .w >
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: N(d dj k 1- WIN4-
Separate Permits are required for any building, mechanical, fire, or plumbing work.
F2 ZC; Z
�a.
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address Un:� ` 2_ ���� $hope 1�r`. A�. Spring Park, MN Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor: ® Or Owner: ❑
Contractor/Company Name: Q5-F Sjz(-e clt,'c. Ela License #: F A 6 9 at �
Address 3d�5 (F,,,^k�i jLcX. �i� City/State: (Akc11i Nl L — Zip: 5W 7
Telephone: Office/Home: Mobile: t( r2 ) 7 td -
E-mail: We—S- /Se`ec' r,LP_yt✓aA- co/tA Fax: ( , -
Builder/Owner Name: MA4V_ \roper }'k'QS
Address (if diff. from Site):
City/State:
Telephone: Office/Home: 12 get - ?? S Mobile: (_) -
E-mail:
Fax: () -
No
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
BUILDINGIFLECTRICAL 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 REQUEST IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE. -7
Signature: �-6- v Date: I Z /
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
$
(� 0-0
o Visa/Master Card - - -
Account Number v �Qv'D
_
F2n Expiration Date
Amount tobewithdrawn
-/V
/CSV
Credit Card Owner Billing Address: 13035 C',�' 1 ` `l '
Street Address
Zip Code
ity, State
Print Name on credit card (REQUIRED)
P nt A orization Signature (REQUIRED)
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Westys Electric
Sales Receipt
Date
Sale No.
3/18/2021
7266
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - 1-21-09, 4177 Shoreline Dr Unit
80.00
80.00
325
Electrical Inspection/Permit Fee - 1-21-10, 4177 Shoreline Dr Unit
80.00
80.00
230
State Surcharge - Electrical
2
1.00
2.00
Total $162.00