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HomeMy WebLinkAboutElectrical Permit 11.112 Reset Form 1 Print Form f p(2}\, 0 For Office Use Only Amount of Check: Check Number: PermitNu - ,.- ELE f / O Z 11=-, altLit Request for Electrical Inspection (REI) (permit) 443 Lafayette Road North St. Paul, MN 55155 -4342 One- and Two-Family Dwellings Phone: (651) 284 -5026 Y s g 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. 10 -21 -2011 * Check One Box: © Contractor or ❑ Homeowner * Check One Box: ❑ New Bldg or Ed Existing Bldg * Check One Box: 12 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 14454 Shady Beach Trail NE 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 Richard Valentine (952) 403 - 0485 * Company Type (check one box) 2 Electrical Contractor ❑ Technology System Contractor * Company License Number * Company Name EA005181 _Russ Orson Electric, Inc * Company Address * City * State * Zip Code 7861 Greer Ave NW Maple Lake MN 55358 * Company Phone Company Cell * Company E -mail Contact Person and Phone Number (320) 963 -7727 (612) 275 -9270 russ@orsonelectric.com Russ 612.275.9270 * 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 12 Yes or ❑ No © Will Schedule Directions to Project Site Master Bedroom Remodel. 6- receptacles, 8- recessed cans, 12 -low voltage puck lights, 7- switches, 2- outside lights, 1- Project Site (Contact Person and Phone Number) smoke detector Electrical Utility TOTAL INSPECTION FEE from REI fee worksheet, or $35 multiplied Enter Inspection Fee Here » 70 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) 75 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, call 1 -800 -342 -5354 (DIAL -DLI) Voice or TDD (851) 297 -4198. Please submit REI forms together with the applicable fees to: MN Dept Labor & Industry, PO Box 64227, St. Paul, MN 55164 -0227 j/ 3 &i CO /4/1 REI 10 (4/11) RE1_10 OneAndTwoFamily.doc (Revised 4/1/11) Request for Electrical M INNESOTA DEPARTMENT OF REI (permit) r LABOR & INDUSTRY Inspection ) �p ) dr 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 (additional 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 less than 50 volts 75¢ /device or apparatus Additional inspection trip(s) 2 $ 35 /inspection trip 70 Investigative Fee (enter values in the Quantity and Fee columns) Other... Other... Other... Other... TOTAL INSPECTION FEE is the fee calculated above, or $35 multiplied by the number of required inspection trips, whichever is greater. 70 Enter Inspection Fee Here & on REI » REI 10 (4/11) REI_10 OneAndTwoFamily.doc (Revised 4/1/11)