Electrical Permit - 4177 Shoreline Drive - 7/15/2021CITY OF SPRING PARK
ELECTRICAL PERMIT
OFFICE USE ONLY
Electric Per rt # L 7-t 2$
Dace Issued: "7 S 21 Receipt #
PLEASE PRINT OR TYPE ALL INFORMATION AND COMPLETE ITEMS ON BOTH PAGES
Quantity DESCRIPTION OF WORK FEES subffotal
,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 Reinspecbon/Bonding/Equipotential Plane/etc. $ 40.00 per ga.
13.. RESIDENTIAL One and Two#amily dwelling units Up to 3 trips Included> In fee
1. New DwellingUnit, u to and includinga 200 am service $ 125.00 er un'
2. New DwellingUnit, 201 am to 400 am service $ 175.00 er unit
3. Existing Dwelling Unit, additions, alterations, or repairs up to & including a 200 amp service,
$ 125.00 per unit
fees as per C & D below but not to exceed
4. Existing Dwelling Unit, additions, alterations, or repairs 201 amp to 400 amp service
175.00 per unit
fees as per C & D below but not to exceed
See C & D below
5. New or Existing Dwelling Unit, 401 amp service or above
C. FEES FOR NEW OR UPGRADED SERVICES, TEMP. SERVICES, GENERATORS;
OTHER POWER SUPPLY SOURCES OR FEEDERS TO SEP. STRUCTURES
1. U to and includinga 200 am service $ 50.00 each
$ 100.00 each
2. 201 am to and including 400 am service
$ 200.00 each
3. 401 amp to and including 800 amp service
$ 300.00 each
4. 801 amp service and above
D. FEES FOR CIRCUITSIFEEDERS b TRANSFORMERS
0 to 200 am $ 10.00 er 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
$ 50.00 per uni
Each dwellingunit
ALARM, COMMUNICATION, SIGNALING CIRCUITS, OF LESS THAN 50 VOLTS
.
Each System Device or Apparatus @ $ .50 each
u,
#3E UN �.F'INWHED.v n PERMIT iS 2X4THE>REQUIRED PERMIT, FEE.
1.00
State Surcharge .0005 of the permit fee (minimum of $1.00)
TOTAL AMOUNT DUE
Do not forget State Surchar a Fee
You m
2-7520 when
Describe Proposed Work: A, } Re-
4-,L ctc Ov_-T--
k is ready for inspection!
c,'ZL)? �ai✓Z
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
OR Legal Description: Lot:
Property ID (PIN No):
q17
Block:
Applicant is: Contractor: ;l Or Owner: ❑
Spring Park, MN Zip:
Subdivision:
Contractor/Company Name: �p 4 ,� E (t j r . . S— nc , License #: F A b6 q L LL
Address: B3 5 Ca ,n , J3a City/State: W otco"►. '-N Zip: S 5-Sf
Telephone: Office/Home: (_� - Mobile: 4 (2 ) M - 70
E-mail:_ ��S E y S e �< < i t �i q 4.r 1. ,. Fax:
Builder/Owner Name: ( O10'e r (i S
Address (if diff. from Site): City/State: Zip:
Telephone: Office/Home: (2 %F IMobile:
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 WITHIN 12 MONTHS OF VALIDATED DATE AND, THAT I AM RESPONSIBLE FOR ENSURING THAT ALL REQUIRED
INSPECTIONS ARE REQUESTED CONF A` J E WITH THE STATE BUILDINGIELECTRICAL CODE.
Signature: �-c Date: z 2
PAYMENT MUST ACCOMPANY APPLICATION (Be sure to include State Surcharge in payment)
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
6 Visa/Master Card — _ _ _ a, `!0Y, �
Account umber Expiration D, atre CSv Amount to be withdrawn
Credit Card Owner Billing Address: 1.3035 COS n � �� ?i d (N A � �: n , M N � 5 31a 7
Street Address City, State Zip Code
'Payment Authorization Signature (REQUIRED) Print Name on credit card (REQUIRED)
l�w_.w__.
MN
952-442-7520 Fax 952-442-7521 888-446-1801
Sold To
Westys Electric
Sales Receipt
Date
Sale No.
7/ 15/2021
7366
Payment Method Check No.
MasterCard
Description
Qty
Rate
Amount
Electrical Inspection/Permit Fee - L21-28 - 4177 Shoreline Dr unit
80.00
80.00
223
State Surcharge - Electrical
1.00
1.00
Total $81.00