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�• .a PERMIT # 12- /0 --
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HOMEOWNER REQUEST FOR ELECTRICAL INSPECTION
Date 3/22/12 Rough -In Inspection Required? 1 Yes Inspection Other Than Rough -in: ® Ready Now
Homeowner Must Schedule All Rough -In Inspections Homeowner Must Schedule All Final Inspections ® Will Schedule
Address of Inspection - Street Project Description: Kitchen remodel
4537 Colorado St. SE
Owner Name
Leander Seurer
Owner Phone
Home: 952- 447 -3155 Cell:
Owner Mailing Address (if different from above) Electrical Utility
PO Box 15, Prior Lake, MN 55372
By signing this document, I certify that I am the owner as defined by Minn. Stat.32 5.01 and will legally perform the electrical work.
Owne ignature
FEE CALCULATION
New Home or Associated Structure Existing Home /Structure Remodel or Addition
New Home Service /Power Supply 0 -400 ampere @ $35 New Home Service /Power Supply 0 -400 ampere @$35
New Home Service 401- 800 ampere @ $60 New Service /Power Supply 401 -800 ampere @ $60
New Home Feeders /Circuits New /Extended Feeders /Circuits Up to 15 Feeders /Circuits ( )
Up to 30 Feeders /circuits $100 Feeders /Circuits @ $6 Each or 16 to 30
New Home - More than 30 Feeders /Circuits (in addition to above New /Extended Feeders /Circuits - More than 30 Feeders/
( ) Feeders /Circuits up to 200A @ $6 Each Circuits ( ) Feeders /Circuits Up to 200 A @ $6 Each
Other (Specify) Reconnected Feeders /Circuits ( ) @ $2 Each
Manufactured Home Park Lot Supply ( ) $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour
Plus ( ) Miles @ The IRS Mileage Rate of ( )
Detached Garage or Other Associated Structure Detached Garage or Other Associated Structure
New Home Service /Power Supply 0 -400 ampere @$35 New Home Service /Power Supply 0 -400 ampere @ $35
New Feeders /Circuits ( ) @ $6 Each New /Extended Feeders /Circuits ( ) @ $6 Each
Other (Specify) Reconnected Feeders /Circuits ( ) @ $2 Each
Other (Specify) State Surcharge = $5.00
TOTAL (the fee calculated above or $35 multiplied by the TOTAL (the fee calculated above or $35 multiplied by the
number of required inspection trips, whichever is greater) number of required inspection trips, whichever is greater) 7
Receipt # ( 53 / /
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The owner
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 $28 will be
added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the
dates stated:
Rough -In Inspection (s) Date Walt Lusian, Electrical Inspector
952.934.0229
Final Inspection Date