Electrical Permit - Permit# L 21-07 - 4413 Lafayette Lane - 3/8/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Permit# L21-4-7
Date Issued: 3(glz-( 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
& C
Additional Inspection trips for Reinspection/Bonding/EquipotentiaI Plane/etc. $ 40.00 per
—Lle.
ye. ev
.....................
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 $_1 25.00per unit
75. - 0 - 0 r unit
2. New Dwelling Unit, 201 amp to 400 —Re
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 &Ebut not to exceed __$ _j 7�5.00 p-eiionit
.below .. . ....... - -
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 --
----
--- 1UEto and including a 200 "m 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 "m $ 10.00 percircuit
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
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)
.......... ...... .
TOTAL AMOUNT DUE
.... ...... (Do not forplet State Surcharge Fee)
1.00
$ e'0
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: PC r(j\
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
OR Legal Description: Lot:
Property ID (PIN No):
L&-,4e_L H-e f{-e Lem c' Spring Park, MN Zip:
Applicant is: Contractor: N Or Owner: ❑
Block: Subdivision:
Contractor/Company Name: j4w�6e_L 1,'t -T;i ,- License #:E 1A&'/ 3 y %3
Address: u'� c. A- x S Q 9 City/State: )3Q� e f- AVl:'
Telephone Offic Home: (7� 3 ) o7Lo 3 - �'33 V Mobile:( ) -
E-mail: j n F-) dtu bin , ce o'\ Fax: ( ) -
Builder/§wner ame: Mk-, , 1 c�u �o. A,,d5E',-)
Address (if diff. from Site):
City/State:
Telephone: Office/Home: ( & S) ) q �) L/ - y�,S�( Mobile: ( �
E-mail:
Fax:
WO
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 TI IAT THE WORK FOR WHICH THE
PERMIT IS ISSUED SHALL BE PERFORMED ACCORDING TO TIIE 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 AR REQUESTED IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Signature: c Date: 3
sure to include State Surcharge in
❑ Check attached — Check # MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspect.com
mnspect.com
FAX: 952-442-7521
MAIUDELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
❑ (Vimaster Card — $ 91,60
- ----
- Acc/o�unt Number Expiration //Date CSV Amount to bewithdrawn
Credit Card Owner Billing Address: P6 ¢,Q,),' _5� c) /& M /V/5 o
Street Address City, State Zip Code
ti h Ce"/,-- c&,-L;. v/)", 241-1-, IL _ I A
Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
�' M N S PE CT,,,,
- --� 335 Flrsl Slrve( Wval • Wvcanly. MN 559B1-I]Ot •
952-442-7520 Fax 952-442-7521 888-446-1801
6Y.7re are
Hubbard Electric
Sales Receipt
Date
Sale No.
3/8/2021
7256
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - 1-21-07, 4413 Lafayette Ln
State Surcharge - Electrical
80.00
1.00
80.00
1.00
Total $81.00