Electrical Permit - Permit# L 21-05 - 3800 Sunset Drive - 3/5/2021Ivid] vu G 1, v l .00d
P.I
CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Per it # L 2-1 -0
Date Issued: 3 S Z Receipt#
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES SublTolaI
A. MINIMUM FEE PER INSPECTION TRIP
Includes up to 4 circuits it more than 4 see Sec. D below $ 40.00 per
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 includinq a 200 amp service S 125,00 per unit
2. New DwellingUnit, 201 am to 400 am service $ 175.00 er 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 S 175.00 per un' t)--�
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. U to and including a 200 amp service $ 50.00 each
0.
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 CIRCUITSIFEEDERS & TRANSFORMERS
0 to 200 amp$ 10.00 per circuit
Above 200 am $ 15.00 per circuit
Transformers u 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 evice or Apparatus @ $ .50 each
D
G. WORK BEGUN OR FINISHED WITHOUT PERMIT IS 2X TIME REQUIRED PERMIT FEE
State Surcharge .0005 of the permit fee (minimum of $1.00)
TOTAL AMOUNT DUE
(Do not forget State Surcharge Feed
1.00
'i
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: N f iG%4�
05
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Separate Permits are required for any building, mechanical, tire, or plumbing work.
PLEASE PRINT OR TYPE ALL INFORMATION AND CON II ETE ITEMS ON BOTH PAGES
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Job Site: Street Address: Moo 50458 / Spring Park, MN Zip:
OR Legal Description: Lot:
Property ID (PIN No):
Block: Subdivision:
Applicant is: Contractor: I Or Owner: ❑
Contractor/Company Name: (t� 1'-1�DC K
�GL✓l �—
�d�-11t�
License #:
Address:'-t0q Vk!r j-14'4 �/�.l
City/State:
(�1+4544.
Telephone: Office/Home: (� // - Mobile: qo -
E-mail:'ShR reC-&,It✓Ct1j' & (i"v'Pi < G��1 Fax:
BuilderlOwner Name: C i L )A V r Uk AS
Address (if diff. from Site):
City/State:
Telephone: Office/Home: Mobile; (�-I- 7
Fax:
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
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:
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in payment)
❑ Check attached —Cheek #
MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspect.com
FAX: 452-442-7521
MAIL/DELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
❑ Visa/Master Card —
Credit Card Owner Billing Address:
Payment Authorization
Account Number
Street Address
WM
EQU IRED)
Expiration Date CSV
Crjr�5kk, /f r -
City, State
c
Amount to be withdrawn
3143
Zip Code
c o'Plgbuirl-
Print Dame on credit card (REQUIRED)
MNSPECTLLC
-- 235 Flit i S tree 1 Wese•Weconia, MN 5 538 1 Y302
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Shamrock Electrical
Sales Receipt
Date
Sale No.
3/5/2021
7251
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-05
State Surcharge - Electrical
50.00
1.00
50.00
1.00
Total $51.00