Electrical Permit - Permit# L 21-06 - 3810 Northern Avenue - 3/8/2021CITY OF SPRING PARK OFFICE USE ONLY
Electric Permit # L 0/ -06
ELECTRICAL PERMIT Date Issued: -l9Iz► Receipt#
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES Sub/Total
. 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.cRESIDENTIAL 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 UPGRADEDSERVICES, TEMP. SERVICES, GENERATORS,
OTHER POWER SUPPLY SOURCES OR FEEDERS TO SEP.'STRUCTURES
1. Uo 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 er 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 2X THE REQUIRED PERMIT FEE
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
DO not for et State Surcharge Fee
$51.W
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: ') — (` M\U*'�)W(M � 1)a�
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: z S VD N Q Spring Park, MN Zip: Sal
OR Legal Description: Lot:
Property ID (PIN No):
Applicant is: Contractor: X
Contractor/Company Name:
Or Owner: ❑
Block:
Subdivision:
License #: E(\ , I
Address: �HL Q% U� A'A`(1t ,y City/State: PV\AW0\L% Zip: M �
Telephone: Office/Home: - J Mobile:
E-mail: _�BW)(\( DE'\ Fax: (`1 3 CjL 01u
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:
PAYMENT NWST ACCOMPANY APPLICATION (Be sure to
Date: �'�J 1_jZ)
❑ 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
�Q Vis aster Card — $
Account Number Expiration Date CSV Amount to be withdrawn
Credit Card Owner Billing Address: 3m V_ 13�� � ��(, i V ") 55ow 1
Street Addiess City State Zi Code
p
Payment thoriza o Signature (REQUIRED) Print Name on credit card (REQUIRED)
M NSPECTLLc
-------- 235 Fiisl Slresl Wasf •Wecanla. MN 5538)-1302
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Harrison Electric
Sales Receipt
Date
Sale No.
3/8/2021
7255
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - 1-21-06, 3810 Northern Ave
State Surcharge - Electrical
50.00
1.00
50.00
1.00
Total $51.00