Electrical Permit - Permit# L 21-04 - 4421 Lafayette Lane - 2/26/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Permit # L,1 i - U `1
Date Issued: �� -A 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
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
Additional Inspection trips for Reinspection/Bond ing/Eq u i potential 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
/ZS
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,
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 CIRCUITS/FEEDERS & 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 60 VOLTS
Each System Device or Apparatus c@ $ .50 each
G. WORK BEGUN OR FINISHED WITHOUT PERMIT IS 2X THE REQUIRED PERMIT FEE
State Surcharge .0006 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: �X;S�`nS �� n, /��Ic7�l £ Loci'-✓ %i�
Separate Permits are required for any building, mechanical, fire, or plumbing work.
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON
PAGES
Job Site: Street Address: i/yZ l LA�R�j F—j T-5 LA V 15
OR Legal Description: Lot:
Property ID (PIN No):
Block:
Applicant is: Contractor: 1�ff- Or Owner: ❑
Subdivision:
55,?'6t4
Contractor/Company Name: Ej'f(�; L LLCM License #: M �'& /07
Address: /C3/�r'i E le, GT City/State:Zip:-
Telephone: Office/Home: 63_) - 6( p,6 Mobile: (7 (,3 ) 2,3 R -
E-mail:_�'.2t-4f.L Uc' � 46zAA;L Cow Fax: Q- S(65_�
Builder/Owner Name: J4 44 t 41o 1, 4 r--•
Address (if diff. from Site): City/State:
Telephone: Office/Home: �) -
E-mail: C:n�S{'tCLb�2
Mobile: (7L3 ) _?5-9 - q�9
s tr • a �c�...� 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: Z'
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
❑ Visa/Master Card - /
Account Number Expiration Date CSv
Credit Card Owner Billing Address:
Street Address City, State
Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
Amount to be withdrawn
Zip Code
MNSPECTLLc
— - 235 F-1 Street West • W 1111, A1N 55387 13G2
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Accurate Electric, LLC
Sales Receipt
Date
Sale No.
2/26/2021
7247
Payment Method Check No.
Check 5650
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee
State Surcharge - Electrical
125.00
1.00
125.00
1.00
Total $126.00