Electrical Permit - Permit# L21-26 - 4100 Spring Street - #101 - 6/29/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OMCE USE ONLY
Electric Permit # L 2-1- 2-
Date Imed: Receipt
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES sub►ratsi
R. MINIMUM FEE PER INSPECTION TRIP
Includes up to 4 circuits if more than 4 see Sec. D below $ 40.00 per
Additional Inspection trips for ReinspectionBonding/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 includina a 200 amp service $ 125.00 per unit
2. New Dwelling Unit 201 amp to 400 amp service $ 175.00 ner 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 FEE ERS TO SEP. STRUCTURES
1. Up to and Including a 200 amp service $ 50.00 each
2. 201 amp to and includina 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 SO VOLTS
Each System Device or Apparatus $ .50 each
.
State Surcharge .0005 of the permit fee (minimum of $1.00)
4
1.00
TOTAL AMOUNT DUE
Do not forget State Surcharge Fee
�,11
You must call 952-442-7520 when work is ready for inspection!
Describe Proposed Work: U-/ 1' yip ,o Ly
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: �/ /4 O :T1 ' :D-_ Icjl Spring Park MN Zip: 2
OR Legal Description: Lot:
ID (PIN No):
Block:
Applicant is: Contractor: ;4 Or Owner: ❑
Subdivision:
Contractor/Company Name: tr_ y7c_ - I` 1 i'� V S Sri✓ `C r 5 License #: rg ?�i
Address: RA A l-k �J^D'R City/State: t&lc,, / 2c,-A o AAAf ZiP ✓�
Telephone: Office/Home: (—�
Mobile: l / '; 73 7 - ;FYQ
E-mail: ,PS���`i�� r�Crr�%�� CS.Cm'Jax:
Budder/Owner Name:
Address (if dill. from Site):
Telephone: Office/Home:
E-mail:
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
BUILDINGAMECTRICAL 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 REOUTESTED IN CONFORMANCE WITH THE STATE BUR DING/SLECPRICAL CODE.
Signature:
Date:
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State &rebarge in payment)
❑ 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
❑ Visa/Master Card — _ w $ OD
Account Number �A Expuaucu „o.. CSV Amount to be withdrawn
Credit Card Owner Billing Address: Re "
`Je 6 k 13,[ V M'k 1 -21--4el M r I f
Street Address City, Zip Code
l if x
Payment A!Qon Signs a (REQUIRED) arlP� t Name on cred[t card (REQUIRED)
M N S P E C T.,,::
----..- 235 First Street Wesi • Weconie, MN SSJ87•-1302
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Elite Facility Svcs
Sales Receipt
Date
Sale No.
6/30/2021
7355
Payment Method Check No.
Visa
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-26 - 4100 Spring St # 101
State Surcharge - Electrical
40.00
1.00
40.00
1.00
Total $41.00