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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