Electrical Permit - Permit# L 21-10 - 4177 Shoreline Drive - 3/18/2021CITY OF SPRING PARK OFFICE USE ONLY
ELECTRICAL PERMIT Electric Per it # L z ( —to
Date Issued: 1 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
2-
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
J
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
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 ampservice $ 50.00 each
2_201 amp to and including_400 amp service $ 100.00 each
3. 401 amp to and including 80_0 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
F. ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ $ .50 each
G. WORK BEGUN OR FINISHED WITHOUT PERMIT IS V 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: f-111- X C kq. ,u ov-i- r Pe+'tea'' _ k4c4n f &,trn ,' 4 (1
o
Separate Permits are required for any building, mechanical, fire, or plumbing work.
Job Site: Street Address: * )nj V 23d 1111 S 6rt 1+,-c Spring. Park, MN Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor: Or Owner: ❑
Contractor/Company Name:i,gs--�/License #:
Address: ,3D�jS Coy n-�,( �(,�, `30 City/State: �0�►�� M\0i zip: S 535�
Telephone: Office/Home: ( .....) - Mobile: (�� i11F -
E-mail: .i2itn
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 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
BUILDING/ELECTRICAL 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.
Signature: Date: _i i%
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/DELMER: MNSPECT, 235 West First Street Waconia, MN 55387
❑ Visa/Master Card — 1i4 0 L�i s oft� T Q fr- n 'r I $ o f
Account Number I Expiration Date CSV Amount to be withdrawn
Credit Card Owner Billing Address:
Street Address City, State Zip Code
a ment Authorization Signature (REQUIRED) Print &ame on credit card (REQUIRED)