HomeMy WebLinkAboutElectrical Permit 11.170 POSTED For Office Use Only
Amount of Check: ge„,a,7Number: /
} MINNESOTA DEPARTMENITOF ELE /1' 0 ` 7�
LABOR & INDUSTRY
443 Request for Electrical Inspection (REI) (permit)
443 Lafay oad North
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St. Paul, M 51554342 One- and Two-Family Dwellings
Phone: (6 84-5026 Y s g
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Fields marked with an asterisk* are required (as applicable). *TODAY'S DATE
Incomplete, inaccurate, or illegible forms may be returned to the submitter. ‘ 1 - 1 C, - \ 1
* Check One Box: Bontractor or 0 Homeowner * Check One Box: 0 New Bldg or XExisting Bldg
* Check One Box: One- Family Dwelling (homeowner or contractor) OR ❑ Two - Family Dwelling (contractors only)
(It Is unlawful for h omeowners to perform electrical work on property that Is ratted, leased or occupied by others)
* Project Location (number & street arse) * Project County
1 ?'-(- OC 412\ 1, Cvc.'e � SC -
* Project Township: (P lease:enter only the township name " Project City: * Project Zip
or the city name, not both) C , U CAt e c: —R -' 9 a
* Owner Name I* Owner Phone Owner Cell Owner E -mail
* mpany Type (check one box)
Electrical Contractor ❑ Technology System Contractor
* Company License Number * Company Name
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* Company Address * City * State * Zip Code
(`I e) - *e S-k--reet S -. R iL t•)M 551c) 9
* Company Phone Company Cell * Company E -mail (Contact Person and Phone Number
Co\ - , Pz-t - 33 acc- 1- 6?C61 timmin. ce, K. riS* Cl CAUS_Vac
* Project Description (Scope of work, service size, quantity of *Single Ins *Rough -in Inspection u
feeders and circuits, job numbers, or other vital information to Other than Rough -in ? Required?
help he electrical inspector make timely inspection service) ❑ Ready Now or
p p y p ) Nil! Schedule ❑Yes or .No
wort r Directions to Project Site
V ICC i;,c Project Site (Contact Person and Phone Number)
Electrical Utility
TOTAL INSPECTION FEE from REI fee worksheet, or $35 multiplied Enter Inspection Fee Here * 2
by the number of required inspection trips, whichever is greater. P J S. ��
A surcharge of $5 is Imposed on every permit effective 7/1110 Surcharge Fee » $ 5.00
as per M.S. § 326B.148, In addition to the inspection fee.
*
* Grand Total (inspection Fee plus Surcharge Fee) Z-V3 . C.xD
Requests for Electrical Inspection (REI) with a fee of $250 or Tess expire 12 months from the filing 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 fees do not carry over from an expired REI to a new REI.
A service charge of $30 will be added for all dishonored checks.
This material can be made available In different forms, such as large print, Braille or on a tape. To request, call 1.800 -342 -5354 (DIAL -DLI) Voice or TDD (651) 297 -4198
Please submit REI forms together with the applicable fees to:
MN Dept Labor & Industry, PO Box 64227, St. Paul, MN 55164 -0227
REI 10 (4/11) REI_10_OneAndTwoFamity.doc (Revised 4/1/11)
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