Electrical Permit - Permit# L 21-20 - 3872 Northern Avenue - 6/7/2021CITY OF SPRM PARK OFFICE USE ONLY
Electric Permit # L 'ZI ZG
ELECTRICAL PERMIT DaftIwue&- (011u
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES suwrow
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
Additional Inspection trips for Reinspecfion/Bonding/Equipotential Planetetc. $ 40.00 per
1. New Dwelling Unit up to and including a 200 amp service $ 125.00 per un
A&WZ
2. New Dwelling Unit 201 amp to 400 amp service $ 175.00 Der 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 er C & D below but not to exceed 175.00 r unit
5. New or Existing Dwelling Unit, 401 amp service or above See C & D below
r;
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 am service and above $ 300.00 each
r.
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
Each dwelling unit $ 50.00 per uni
Each S stem Device or Apparatus $ .50 each
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE(,
Do not forget State Surcharge Fee
You must call 952442-7520 when work is ready for inspection!
Describe Proposed Work:
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: 3,91A NWf Wrr1 JI t Spring_Park. MN Zip: `Sy
OR Legal Description: Lot:
Property ID (PIN No):
Block:
Subdivision:
Applicant is: Contractor: PS Or Owner: ❑
Contractor/Company Name: ,( G License #:
�e A '
Address: b i i 10-� C / K) City/State:_Mul e Lwr_.k Zip:
Telephone: Office/Home: G ) 9(11 - V�Z � Mobile: (U�
E-mail: : S e Jet4noc P I Ul✓l Fax:
Builder/Owner Name:A — s
Address (if dill. 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 ST R WICHOU r A PEi�MiT, 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
BUILDINGM-ECTRICAL 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: 2_A/L�n 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 Wacpnia, MN 55387
Visa/Master Card — ,
Account Number Expiration Date CSV Amount to � OD
withdrawa
Credit Card Owner Billing Address: L4 NI y )1 timAictm . d
Street Address City, State Zip Code
_SO)_,rA (idersov-)
Paym&�� �stumm UIRED) Print Name on credit card (REQUIRED)
%Y M N S P E C T,,-r-
......_- 235 First Street Weef • Weconie, MN 5538]-1302
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
SP Electric
Sales Receipt
Date
Sale No.
6/7/2021
7333
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - 1,21-20, 3872 Northern Ave
State Surcharge - Electrical
125.00
1.00
125.00
1.00
Total $126.00