Electrical Permit - Permit# L 21-21 - 2447 Black Lake Road - 6/7/2021CITY OF SPRING PARK OFFICE USE ONLY
ELECTRICAL PERMIT Electric Per t # L y l -z
Date Issued: U7 Z I Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK
FEES Subrrotal
A. MINIMUM FEE PER INSPECTION TRIP
�.,
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
(J
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 er 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
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 forget State Surcharge Fee
0
You must call 952442-7520 when work is ready for inspection!
600
Describe Proposed Work: /nsAp//
tom, 1G'GO� /i Glrio ter i d,"ratz, 4-'r 14 c'r Gr, r-tpym .
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: 251"4 7 1312?4 Z,:Pk Al
OR Legal Description: Lot:
Property ID (PIN No):
Block:
Applicant is: Contractor: LY Or Owner: F1
Contractor/Company Name:V
Address: 1666r�►��P
'Ic
Spring Park, MN Zip: 6_�_ 31?Zf
Subdivision:
License #• F-4f 78/ 767
City/State: 5h 4 Pee Zip: S'5 3 7
Telephone: Office/Home: �)2� -7� 02 Mobile: ( 612) S�249 - 762•6
E-mail: !�' CD����e' i'C p Fax:
U_
Builder/Owner Name: 5a-) 4�- SU `i" � -e,
Address (if diff. from Site):
City/State:
Telephone: Office/Home: ( ) - Mobile: �D( S� ) 33s- - -S-7 i u
E-mail: 19 C1 to '7b 'jgi" co,- Y, Fax: (�
Zip:
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 O VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE REQUESTED INJCONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Signature:
Date:
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in payment)
o Check attached - Check #
MAKE CHECKS PAYABLE to MNSPECT
EMAIL: electrical@jnnspect.com
FA,X• 952-442-7521
AIL/DELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
VVisa/Master Card -.
p /Accouni I4mber y,� Expiration Date �CSV Amount to be withdrawn
Credit Card Owner Bi in ddress: L �66 'eipy-�si "' e 51Z�1 � Ce SS-37 c7
Street Address City, S to Zip Code
Pay tion Signature (REQUIRED) Print Name on credit card (REQUIRED)
MNSPECTLLG
-- �--- 335 Fifsi Slave! Wvai • Weconie. MN 5598>-130a
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Victor Electric
Sales Receipt
Date
Sale No.
6/7/2021
7334
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee, L21-21 - 2447 Black Lake Rd
State Surcharge - Electrical
80.00
1.00
80.00
1.00
Total $81.00