Electrical Permit - Permit# L 21-08 - 2401 Interlachen Road - 3/15/2021RECEIVED MAR 18 2021
CITY OF SPRING PARK OFFICE USE ONLY
Electric Permit # L Z + C �'
ELECTRICAL PERMIT
Date Issurd: _ 3fS�ZI Itrreipt N
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES subrrotat
_ A. MINIMUM FEE PER INSPECTION TRIP
Includes up to 4 circuits if more than 4 see Sec. D below _ _ $ 40.00 per W
Additional Inspection trips for Reinspection/Bon_ding/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 $ 175.00r 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,
1. Up to and including a 200 amp service
2. 201 amp to and including 400 amp service
3.401 amp to and including 800 amp service
4. 801 amp service and above
I. 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 OR FINISHED WITHOUT PERMIT IS 2X THE REQUIRED PERMIT FEE
$ 50.00 each
$ 100.00 each
_ $ 200.9p each
$ 300.00 each
State Surcharge .0005 of the permit fee (minimum of $1.00) 1 1.00
TOTAL AMOUNT DUE
_ (Do not forget State Surcharge Fee) 4
You must call 952442-7520 when work is ready for inspection!
Describe Proposed Work:
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:'L1A(j nek10.Gheanvinc>I.d Siring Park, MN Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor: 2 Or Owner: O
Contractor/Company Name:AM LANI . EycwiC License #:
Address:' 0 k 'T, AW X airpj-A KL1t., city/state:6eri, u- LAM zip:5R) I
Telephone: Office/Home: ('11D'1) ) - 60jaD _ Mobile:(-----) -
E-mail: Filu 1102.2 WL-h i r. i n i Q i t. (_LjQ Fax:
Builder/Owner Name:
Address (if dill from Site):y(�� gjaC ' jVd City/StatcS .� ntIis Yl� AANZip:�k Le
Telephone: Office/Home: (U-ft ) PST-� - Q�t,�j_ Mobile: ( -
E-mail: Fax:
I HEREBY APPLY FOR AN ELECTRICAL PERMIT, AND I ACKNOWLEDGE THAT THE INFORMATION ABOVE 1S 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 WT IIN 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: t j I ()anQa n() Date: aW it l?w
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in payment
o Check attached — Check # MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspect.com
FAX: 952-442-7521
AIIJDELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
Visa/Master Card — _ _ $ LA i -co
Account Number Expiration DateLS
— Amount to be withdrawn
Credit Card Owner Billing Address:1111a TL11WX t,;r NQ _ L;eA&k-- Lkk) 55 b I
et Address City, State Zip Code
�.� too-v St"YN
Payment Authorization Slakture (REQUIRED) Print Name on credit card (REQUIRED)
MNSPECTLLC
------ 235 F-1 S11ee1 Wes, • ft-1e. MN 553311302
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Fine Line Electric
Sales Receipt
Date
Sale No.
3/15/2021
7260
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-08, 2401 Interlachen Rd
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00