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HomeMy WebLinkAboutElectrical Permit 11.160 - Minnesota Department of Labor and Industry 443 Lafayette Road North St. Paul, MN 55155 -4342 42,6667 r2 j (o 4 4' 7 Phone: (651) 284 -5026 11 Permit Number w .dli.mn.gov \ 0 L PP I 0 (N - � , t, // inr _ V f / & O (0(-6A L, (" Contractor Request for Electrical Inspection Form TODAY'S DATE Permit Type: Existing One- or Two- Family Dwelling [ELE EXST 1 OR2 FAN] t k - 1,0 1,1 and Accessory Structures Property /Job Site Address Site City Site Township Site ounty Site Zip Code 3 t ( (k T T- _ ✓''t 2 C Cr , c c i -ct I/� 5' 5 3 -7 ei Owner Name Owner Phone Owner Cell Owner E -mail COCA• t 5 Company License /Registration Number Company Name . Company Type (check one box) t A 0 0 t t c L a IA , , EL c.):1 C_ 'IA Electrical Contractor Company Address City State Zip Code ❑ Technology System Contractor - 5 5 i✓..,/ l '13 t^ c4 a-- 5 c, v !At vt 57/ Company Phone I Company Cell ' Company E -mail Company Contact P son and Phone Number Permit Sub -Type (check one box) Project Short Description Residential Existing Project Long Description 1 , / Single Inspection Other than Rough -in? Rough -in Inspection Required? _To,. zi t, l y °V`Q. � ' 5 v ` c L _.€.,4 -- vl. Ready Now ❑ Will Schedule ❑ Yes f. No Electrical Utility Job Site Contact Person n IA ©L t-eAt Directions to Job Site 0 tc 400 Amp Power Source ( ) @ $35 Tech Circuits & Circuits less than 50 401 - 800 Amp Power Source ( ) @ $60 Inspection Hourly Rate ( ) @ $80 Over 800 Amp Power Source ( ) @ $100 Inspection Mileage Rate ( ) miles @ 50¢ 0 to 200 Amp Circuit or Feeder ( ) @ $6 Supplemental Over 200 Amp Circuit or Feeder ( ) @ $15 Reinspection Fee ( ) @ $35 Existing One- or Two - Family Dwelling (where more than 14 Investigation Fee (A minimum of $70, or equal to the total feeders or circuits are installed or extended) $100 inspection fee, whichever is greater, not to exceed $1000) Existing One- or Two - Family Dwelling (where 14 or less feeders TOTAL FEE is the fee calculated above, or $35 multiplied by J ‘7'/l or branch circuits are installed or extended) ( ) @ $6 /crct the number of required inspection trips, whichever is greater. Reconnect Circuit or Feeder ( ) @ $2 A surcharge of $5 is imposed on every permit effective 7/1/10 as per M.S. § 326B.148 $5.00 Separate Bonding Inspection ( ) @ $35 Grand Total b Li lnsp of Concrete - encased Grounding Electrode ( ) @ $35 0 �^ 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 one REI to another. A service charge of $30 will be added for all dishonored checks. I hereby 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 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. REI 04 (7/10) REI 04 Contractor Exstlor2Family.doc (Revised 7/1/10)