Electrical Permit - Permit# L21-27 - 4389 Warren Avenue - 7/2/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Permit # L 21 7-1
Date Issued: 7 2- Z Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES subrTotal
k. MINIMUM FEE PER, INSPECTION TRIP _ .. .,,.
, _ .
1
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
$40.00
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 unitl
2. New Dwellina 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
l 1
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 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 50 VOLTS
Each S stem Device or ARearatus @ $ .50 each
. 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
r 41.00
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work:
Hang 6 Exterior Lights and 2 Outlets on Exterior of House
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: 4389 Warren Ave
OR Legal Description: Lot:
Property ID (PIN No):
Block:
Applicant is: Contractor: [S Or Owner: ❑
Syrintt Park, MN Zip: 55384
Subdivision:
Contractor/Company Name: Advanced Electrical Services Inc. License #: EA006604—`
Address: PO Box 427 City/State: NYA, MN Zip: 55368
Telephone: Office/Home: 9( 52 ) 467 - 3490 Mobile: ( 952 ) 847 - 0001
E-mail: dustin(a,advancedelectricalservicesmn com Fax
Builder/Owner Name:
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 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 nEM2 MONTHS OF VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARVMUESTED IN CONFORMANCE WITH THE STATE BUIIAING/ELECTRICAL CODE.
Signature:
Date: 7 I 2
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
MAIL/DELIVER: MNSPECT, 235 West First Street Waconia, MN 55387
X Visa/Master Card —
Account Number
Expiration Date CSV
Credit Billing Address: 12515 Salem Ave NY& MN
Street Address City, State
Dustin Mackenthun
$ 41.00
Amount to be withdrawn
Payment Authorization gignatore (REQUIRED) Print Name on credit card (REQUIRED)
55368
Zip Code
MNSP;ECT,-,-,:
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Advanced Electrical
Sales Receipt
Date
Sale No.
7/2/2021
7356
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-27 - 4389 Warren Ave
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00