Electrical Permit Application - City Of St. Louis Park, Minnesota

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City of St. Louis Park

Electrical Permit Application

Job Site Address: ___________________________________________ Unit # __________ Zip __________

Project Valuation: $___________________________

The Applicant Is:

Owner

Contractor

(must include fair market value of material and labor costs)

Property Owner *Required*

Name___________________________________________Email_______________________________________

Address__________________________________________________________________ Unit # ____________

City ______________________________________________________________ State ______ Zip __________

Phone (

)

Contractor

Name___________________________________________Email_____________________________________________

Address_____________________________________________________________________________________

City ______________________________________________________________ State ______ Zip __________

Phone (

)

MN State EL License #

Property Use

Type of Structure

Type of Work

Residential

Principal Building

New Building

Disconnect

Commercial

Garage

Existing Building

Code Compliance

Industrial

Accessory Building

Addition

Sign - Other

Institutional

Temporary Building

Remodel

Sign - Permanent

Public

Swimming Pool

Repair / Replace

Sign - Temporary

Other__________

NSP Savers Switch

Electrical Item(s)

(indicate quantity for each)

___ Air Conditioner

___ Furnace

___ Opening - Light

___ Sign

___ Annunciator

___ G.F.I. Receptacle

___ Opening - Other

___ Smoke Detector

___ Appliance

___ Heat Detector

___ Opening - Receptacle

___ Subpanel

___ Boiler / Hot Water

___ Indicating Device

___ Opening - Switch

___ Temporary Service

___ Branch Circuit

___ Initiating Device

___ Pool / Spa / Hot Tub

___ Ventilation

___ Central Station Control

___ Office Furniture -

___ Potable Hot Water

Equipment

___ Control Panel

Feeds Only

___ Refrigeration Equipment

___ Water Flow

___ Disconnect

___ Office Furniture -

___ See Remarks

Detector

___ Feeder

Partition Wiring

___ Service

___ Whirlpool Tub

Specific Description of Work to be Completed

Permit will become void one year from date of issuance. Permits issued and inspections made by the City are a public service and do not constitute any representation,

guarantee or warranty, either implied or expressed, to any person as to the condition of the building or conformance to applicable construction codes. The Undersigned

acknowledges that this application has been read and that the above is correct and agrees to comply with all the ordinances and laws of the City of St. Louis Park regulating

building construction.

Some or all of the information that you are asked to provide on the application is classified by State law as either private or confidential. Private data is

information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to

either the public or the subject of the data. Our purpose and intended use of this information is annually to update our records and records of other governmental agencies

required by law. If you refuse to supply the information, the permit may not be issued.

Applicant’s Name & Signature

Date

Print & Sign Name

Permit # ______________________

Called ______________________ Ck_________ CC

OFFICE USE

ONLY

Entered ____________ Zoning App/Date _____________ Approval /Date ________

Issued __________