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HomeMy WebLinkAboutElectrical Permit 11.174 Minnesota Department of Labor and Industry 443 Lafayette Road North 5t. Paul, MN 55155-4342 /26C677 6, Phone: (651) 284 -5026 Permit Number / www.dli.mn.gov / / / 0 f 4 f Contractor Request for Electrical Inspection Form TODAY'S D Permit Type: Existing One- or Two- Family Dwelling [ELE EXST 1 OR 2 FAM) L tc_. `7 Z a 11 and Accessory Structures Property/Job Site Address Sit City Site Township Site County Site Zip Code 1 1 1k L- 0 ,4- ti<.5E I r )st Sc O Owner Name � (! Owner Phone Owner Cell Owner E -mail 1 -II1 (t.f,v1))0""r /) y-'141 Company License/Registration Number Company Name Company Type (check one box) CA 04780 MJ ELECTRIC MN INC El Electrical Contractor Company Address City State Zip Code ❑ Technology System Contractor 10731 UPTON AVENUE S BLOOMINGTON MN 55431 Company Phone Company Cell Company E -mail Company Contact Person and Phone Number (612) 598 -0793 (952) 888 -5616 mjelectric @comcast.net MIKE JOHNSON (952) 888 -5616 Permit Sub -Type (check one box) Project Short Description © Residential Existing 34-4‘-. Project Long Description Single Inspection Other than R ugh -in? Rough -i spection Required? R AA'44� � r c -.C. 1 ❑ Ready Now Will Schedule Yes ❑ No Electrical Utility Job Site Contact Person /rA- 1%,/ur,5s - l).4-111 Directions to Job Site 0 to 400 Amp Power Source ( ) © 535 Tech Circuits & Circuits less than 50 Volts ( ) 0 75¢ 401 - 800 Amp Power Source ( ) @ 560 Inspection Hourly Rate ( ) @ 580 Over 800 Amp Power Source ( ) © 5100 inspection Mileage Rate ( ) miles Q 50¢ 0 to 200 Amp Circuit or Feeder ( ) © E6 Supplemental Fee ( ) © 535 Over 200 Amp Circuit or Feeder ( ) @ 515 Reinspection Fee ( ) @ 535 Existing One- or Two-Family Dwelling (where more than 14 Investigation Fee (A minimum of 570. or equal to the total feeders or circuits are installed or extended) 5100 inspection fee. whichever is greater. not to exceed 51000) Existing One- or Two - Family Dwelling (where 14 or less feeders TOTAL FEE is the fee calculated above. or 535 multiplied by or branch circuits are installed or extended) ( ) @ 56/crct the number of required inspection trips. whichever is greater. A surcharge of $5 is imposed on every permit effective 55.00 Reconnect Circuit or Feeder ( ) @ 52 7/1/10 as per M.S. § 3266.148 Separate Bonding Inspection (, ) © 535 Z Tr` ` P S o- Grand Total Insp of Concrete - encased Grounding Electrode ( ) @ 535 Requests for Electrical Inspection (REI) with a tee of 5250 or less expire 12 months from the tiling date. The installer must have the work completed within the 12 month period or submit another REI that Includes the inspection fee for the uncompleted work. Inspection tees do not carry over from one REI to another. A service charge of 530 will be added for all dishonored checks. thereby certify that I inspected the electrical installation herein on the dates stated: For Department Use Only Rough - In Inspection(s) Date Final Inspection Date This material can be made available in different tortes, such as large print, Braille or on a tape. To request, call 1 - 800 - 342 (DIAL - OU) Voles or T001651)297-4198. REt 04 (7/10) REI 04 Contractor Exstlor2Family.doc (Revised 7/1/10)