Electrical Permit - Permit# L21-22 - 4770 West Arm Road - 6/23/2021CITY OF SPRING PARK OFFICE USE ONLY
Electric Permit # L A I — a
ELECTRICAL PERMIT Date Issued: (' . -3 1 kteceipt#
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK
FEES Sub/Total
A. MINIMUM FEE PER INSPECTION TRIP
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
$40
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
. 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
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 REQUIlRED PERMIT'FEE
State Surcharge .0005 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
Do not forget State Surcharge Fee
41
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: Reconnecting new furnace
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: 4770 West Arm Rd
Spring Park, MN Zip. 55384
OR Legal Description: Lot: Block: Subdivision:
Property ID (PIN No):
Applicant is: Contractor: V Or Owner: ❑
Contractor/Company Name: Lumberjack Electric LLC
Address: 5720 International Pkwy
Telephone: Office/Home: 6( 12 ) 238 - 9702
E-mail: april.clemens@heypaul.com
Builder/Owner Name: Marlin Wiggins
Address (if diff. from Site):
Telephone: Office/Home: O
I E-mail:
License #: EA774619
City/State: New Hope, MN Zip: 55428
Mobile: ()
Fax: (� -
City/State:
- Mobile: (�
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 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: _411�0 eCA41t� Date: 6/17/21
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in vavment
❑ 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
w6 Visa/Master Card —
Account Number
Credit Card Owner Billing Address: 5720 International Pkwy
Street Address
a
S41
Expiration Date CSV Amount to be withdrawn
New Hope MN 55428
City, State Zip Code
Pat McGuire
Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
r' MNSPECT,,.
----- 235 Fiisl Steel West • Weconie, MN 55J8)-1302
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Lumberjack Electric
Sales Receipt
Date
Sale No.
6/28/2021
7347
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-22 - 4770 West Arm Rd
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00