Permits - Permit# L20-15 - 4325 Channel Road - 1/1/2020.w
CITY OF SPRING PARK OFFICE USE ONLY
ELECTRICAL PERMIT Electric PeMdi
# L 70 -t5'
Date Issued: 2D Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK
FEES Sub/rota)
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 I 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
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
E
Transformers up to 10 KVA $ 20.00 each
Transformers over 10 KVA $ 30.00 each
E. MULTI -FAMILY DWELLINGS y
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 WITHOUTPERMIT 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
$
11X6C>
You must ca11952-442-7520 when work is ready for inspection!
Describe Proposed Work: p e &-le, -/I- jV e
Separate Permits are required for any building, mechanical, hire, or plumbing work.
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PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Job Site: Street Address: I-W5 6hi&'1 #CC R66c( Spring Park, MN Zip:
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor: Pd Or Owner: l]
Contractor/Company Name: &.i/0 h e c-i A'(, /7G` License #: f,�%j
Address: Y,2,tr 66e-y" ` 16n e City/State: j2 off; /_ R j� /'9/y Zip: Z4
Telephone: Office/Home: () - Mobile:( 7%(�j 22
E-mail: :44q Fax:
Builder/Owner Name: 6 % e ire //,f j
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; 1
UNDERSTAND WORK IS NOT TO START WITHOUT A PERMIT. 1 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, LF 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.
' 7-a y-GAG
Signature: ���— �,e�-� Date:
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in payment)
❑ Check attached — Check # MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@mnspect.com
FAX: 952-442-7521
MAILMELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
❑ Visa/MasterCard— $
Account Number Expiration Date t v Amount to be withdrawn
Credit Card Owner Billing Address. I " � v
Sheet Address City, to Zip Code
gym; "T Fry 1/�
Pay ent Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
�- MNSPECT„.-
Hn, S".., Weal. W,...... MN 5530-302 ..
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Provo Electric
Sales Receipt
Date
Sale No.
7/30/2020
7051
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L20-15, 4325 Channel Rd
State Surcharge - Electrical
125.00
1.00
125.00
1.00
Total $126.00