Electrical Permit - Permit# L21-23 - 3865 Sunset Drive - 6/24/2021CITY OF SPRING 71� G P ♦ Tf K OFFICE USE ONLY
ELECT�C i�\ll\P�Es�ti.IRTi1 Electric Permit # L 02.
Date Issued: . i} i Receipt ##
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES Sub/Total
. MWIMUM I=EE PER INSPECTIM TRIP
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
D.v
Additional Inspection trips for ReinspectionBondinglEquipotential Plane/etc. $ 40.00 per
8 . RE$IDENT1AL: . . Dne and Tvt64= dweiling units Up toR 3 gips included in flee;
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
. FEES FOR CIRcutirS1FEEpeks & iRANSFl i1l1ERS
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 t1WEi.LINGS'
Each dwelling unit $ 50.00 per unit
F. ALARM, COMMUNICATION, SIGNAGNG CIRCUITS, OF LESS THAN 50.VOLTS
Each System Device $$ .50 each
�oortApparatus �a@
State Surcharge _OOD5 of the permit fee (minimum of $1.00)
1.00
TOTAL AMOUNT DUE
Do not forget State Surcharge Fee
�l •'�°
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work OA Co `L.w- 0 4, V 64 rz,('k-
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: 6D Spring Park, MN Zip:
I OR Legal Description: Lot: Block: Subdivision:
I Property ID (PIN No):
IApplicant is: Contractor: 01 Or Owner: ❑
Contractor/Company Name:
li .d R44ic_
Li-c—
License#• �-+A �'806'"1
Address: � c' -2
r
City/State:
1i* ' . ✓, A Zip: S' 3
Telephone: Office/Home: ( ..... -
E-mail: e,,
I Builder/Owner Name:
Address (if dill. from Site): %'
Telephone: Office/Home:
I E-mail:
Mobile: ( EE- 34'7
Fax: ()
City/State: /i
Mobile: �t- &" -7
Fax: ( ) -
Zip: /i
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 WITIiOUT 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 WITE N 12 MONTHS OF VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS Ajq REQUESTED IN CONFORMANCE WITH THE STATE BUILDING/ELECTRICAL CODE.
Signature:
Date:
o 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
q- Visa/Master Card — $ yr, CAC
Account Number Expiration Date CSV Amount to be withdrawn
Credit Card Owner Billing Address_^
Street Address City, State Zip Code
1y1 rI n&dC' 10"_4'4 -rt Gc.c_
,Pyyment Authorization Signature (REQUMED) Print Name on credit card (IREQIIIItED)
MNSPECTLLC
952-442-7520 Fax 952-442-7521 888-446-1801
6 • fl i7
Pinnacle Electric
Sales Receipt
Date
Sale No.
6/28/2021
7348
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-23 - 3865 Sunset Dr
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00