Permits - Permit# L17-027 - 2494 Black Lake Road - 1/1/2017R
CITY OF SPRING PARK OMCE USE ONLY
Electric Permit # L-0'Za
ELECTRICAL PERMIT Dateissued: �! �s1 t li Receipt#
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK
FEES Subrrotal
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
B. RESIDENTIAL One and Twodamily dwelling units Up to 3 trips Included in fee
1. New Dwelling Unit up to and including a 200 amp service $ 125.00 per uni
2. New Dwelling Unit, 201 amp to 400 amp service $ 175.00 per uni
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 oer 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
1. Up to and including a 200 amp service $ 50.00 each
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 am $ 10.00 per circuit
Above 200 am $ 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. FOR INSPECTIONS NOT COVERED ON THIS FORM OR FOR REQUESTED SPECIAL
INSPECTIONS
Hourly charge $ 57.00 per hour
. GO . MERCIAL PLAN R_EYIEW E'(IF REQUIRED) its 35"�6 0� Total `Permit Fee - _
. WORK;BEGUN OR FINISHED WITI4OUT'PERMIT IS 2X 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
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You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: "i
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Separate Permits are required for any building, mechanical, fire, or plumbing work. \�
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PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: �G.C_ C - 2 Spring Park, MN Zip: '5-36G
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor:x— Or Owner: ❑
Contractor/Company Name: �f"'��� E� �7`( iL-G _3 ���/1DY License #: ��y
Address: 7 / / � -yw City/State: Vy k-ui Zip:
Telephone: Office/Home: (�r) �) - � Mobile:
E-mail: C5 V) %C% L o, Fax:
Builder/Owner Name: T• G/ly l.L
Address (if dill. from Site): City/State:
Telephone: Office/Home: ( ) - Mobile: L_)
E-mail: 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 DA , THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE REQUESTED IN COONFORMAN ,_... , BUILDING/ELECTRICAL CODE.
Signature: Date:
PAYMENT rTACCOMPANY APPLICATION(Be sure to include State Surchar a in a ent
o Check attached — Check # MAKE CHECKS PAYABLE to MNSPECT
MAIL: MNSPECT, P.O. Box 342, Waconia, MN 55387
FAX: 952-442-7521 .� - _
DELIVER: MNSP��
s-
❑ Visa(Master Card —
Credit Card Owner Billing
(REQUIRED) Print Name n credit card (REQUIRED)
MNSPECTLL. _
—_� 205 Fuel S-11 Weel • --ie. UN 6538 1002
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Complete Electrical Solutions
Sales Receipt
Date
Sale No.
8/15/2017
5161
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Pen-nit Fee - L17-027
State Surcharge - Electrical
225.00
1.00
225.00
1.00
Total $226.00