Electrical Permit - Permit# L 21-19 - 2447 Black Lake Road - 6/2/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Permit # L 7 ( -icf
Date Issued: Z z t Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
cuoneity DESCRIPTION OF WORK FEES subrrow
A. MINIMUM FEE PER INSPECTION TRIP
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
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Additional Inspection trips for Reinspection/Bonding/Equipotential 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
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
.ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 60 VOLTS
Each System Device or Apparatus $ .50 each
State Surcharge .0006 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
Do not forget State Surcharge Fee
40
You must ca11952-442-7520 when work is ready for inspection!
Describe Proposed Work:
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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: 2 yy 7 QIa�� L4�, RJ Spring Park. MN Zip: 5S-3 g y
OR Legal Description: Lot:
Property ID (PIN No):
Applicant is: Contractor: ❑ Or Owner:
Block:
Subdivision:
Contractor/Company Name: License #:
Address:
Telephone: Office/Home: �) -
E-mail:
Builder/Owner Name: -5c vft 75,4-k e.
City/State: Zip:
Mobile: �)
Fax:
Address (if diff. from Site): City/State: Zip:
Telephone: Office/Home: (6 S! ) 33 S - 57/6 Mobile:
E-mail:nj_ I T .76 @ -a '. cc rn 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 WELL 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: ,�`1 � Date: �za l /
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in Mment)
X 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
o Visa/Master Card -
l
Account Number Expiration Date
Credit Card Owner Billing Address:
Street Address City, State
Payment Authorization Signature (REQUIRED)
CSV Amount to be withdrawn
Print Name on credit card (REQUIRED}
Zip Code
MNSPECT,,,,
----- 335 Firat Street Weat • Waconie. MN S'— —2
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Scott Suttle
Sales Receipt
Date
Sale No.
6/2/2021
7331
Payment Method Check No.
Check 5751
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - 1-21-19, 2447 Black Lake Rd
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00