HomeMy WebLinkAboutElectrical Permit 11.155 Reset Form Print Form
For Office Use Only
Amount of Check: Number, /fi L _
Itr
MINNESOTA DEPARTMENT Cif o 4 ELE 1 j. 0/55
LABOR & INDUSTRY
Request for Electrical Inspection (REI) (permit)
443 Lafayette Road North
St. Paul, MN 55155 -4342 One- and Two-Family Dwellings
Phone: (651) 284 -5026 J
www.dli.mn.gov
Fields marked with an asterisk * are required (as applicable). * TODAY'S DATE
Incomplete, inaccurate, or illegible forms may be returned to the submitter. 11/01/2011
* Check One Box: 2 Contractor or ❑ Homeowner * Check One Box: ❑ New Bldg or ❑ Existing Bldg
* Check One Box: EA One - Family Dwelling (homeowner or contractor) OR ❑ Two - Family Dwelling (contractors only)
(It is unlawful for homeowners to perform electrical work on property that is rented, leased or occupied by others)
* Project Location (number & street name) * Project County
3250 SYCAMORE TRAIL SCOTT
* Project Township: (Please enter only the township name * Project City: * Project Zip
or the city name, not both) PRIOR LAKE 55372
* Owner Name * Owner Phone Owner Cell Owner E -mail
VICK RANTALA (952) 226 -2368 ,
* Company Type (check one box)
0 Electrical Contractor ❑ Technology System Contractor
* Company License Number * Company Name
EA006479 MIDWEST ELECTRIC AND GENERATOR, INC.
* Company Address * City * State * Zip Code
900 6TH STREET NW MAPLE LAKE MN 55358
* Company Phone Company Cell * Company E -mail Contact Person and Phone Number
(612) 284 -1550 (612) 290 -5225 MALINDA@MIDWESTGENERATORS.COM JOHN
* Project Description (Scope of work, service size, quantity of *Single Inspection *Rough -in Inspection
feeders and circuits, job numbers, or other vital information to Other than Rough -in? Required?
help the electrical inspector make timely inspection service) ❑ Ready Now or
F Will Schedule ❑Yes or p No
Directions to Project Site
ROOF DE -ICING HEAT CABES Project Site (Contact Person and Phone Number)
ADDED GFCI CIRCUIT
Electrical Utility
TOTAL INSPECTION FEE from REI fee worksheet, or $35 multiplied Enter Inspection Fee Here » * 35
by the number of required inspection trips, whichever is greater.
A surcharge of $5 is imposed on every permit effective 7/1/10 Surcharge Fee» $ 5.00
as per M.S. § 326B.148, in addition to the inspection fee.
*
* Grand Total (Inspection Fee plus Surcharge Fee) 40
Requests for Electrical Inspection (REI) with a fee of $250 or less 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, cat 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_OneAndTwoFamily.doc (Revised 4/1/11)
Request for Electrical
MINNESOTA DEPARTMENT OF I
Inspection (REI) (permit)
t ABOR & INDUSTRY p ) �p
443 Lafayette Road North
St. Paul, MN 55155.4342
Phone: (651) 284 -5026 Inspection Fee Worksheet
www.dli.mn.gov
Item Description Quantity Fee Total***
0 to 400 Amp Power Source $ 35 /source
401 - 800 Amp Power Source $ 60 /source
Over 800 Amp Power Source $ 100 /source
0 to 200 Amp Circuit or Feeder $ 6 /feeder or circuit
Over 200 Amp Circuit or Feeder $15 /feeder or circuit
New One- or Two-Family Dwelling
(up to 30 circuits and feeders per unit) $ 100 /dwelling unit
New One- or Two-Family Dwelling
Sadditional circuits over 30 per unit) $ 6 /feeder or circuit
Existing One- or Two-Family Dwelling
(where 15 or more feeders or circuits $ 100 /dwelling unit
are installed or extended per unit)
Existing One- or Two-Family Dwelling
(where less than 15 feeders or circuits $ 6 /feeder or circuit
are installed or extended per unit)
Reconnected Existing Circuit or Feeder (for panelboard replacements) $ 2/feeder or circuit
Separate bonding inspection $ 35 /inspection
Inspection of concrete- encased grounding electrode $ 35 /inspection
Technology circuits & circuits Tess than 50 volts 75¢ /device or apparatus
Additional inspection trip(s) $ 35 /inspection trip
Investigative Fee (enter values in the Quantity and Fee columns)
Other... 1 TRIP 1NSPECTON 1 35 35
Other...
Other...
Other...
TOTAL INSPECTION FEE is the fee calculated above,
or $35 multiplied by the number of required inspection trips, whichever is greater. 35
Enter Inspection Fee Here & on REI »
REI 10 (4/11) REI_10 OneAndTwoFamily.doc (Revised 4/1/11)