HomeMy WebLinkAboutElectrical Permit 12. 0138 OF PRtp4
PERMIT # 12-
u n
'" NI CONTRACTOR/ REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough-in Inspection Required ? 5( Yes Inspection Other Than Rough-in : 0 Ready Now
Contractor/Employer Must Schedule All Rough-In Inspections Contractor/Employer Must Schedule All Final Inspections
Will Schedule
Address of Inspection — Street Project Description :
Owner Name j
/ O ���
Owner Phone
Home : Cell :
Contractor/Registered Employer Name Contractor/Registered Employer Mailing Address
Contractor/Employer Telephone Number Contractor/Employer E-mail Address Electrical Utility
Work : Cell : / L N I'7
fG1 '
Contrac ' r/Employer Authorized Sig re Contractor License Number Job/Project Contact Person :
FEE CALCULATION
Service/Power Supply 0-400 ampere @ $35 Technology Systems Devices ( ) @ $ .75 Each
Service/Power Supply 401 - 800 ampere @ $60 Separate Bonding Inspections for Swimming Pools and
Equipotential Planes ( ) @ $35 Each
Service/Power Supply Above 800 ampere @ $ 100 Center Pivot Irrigation Booms ( ) @ $35 Each
Plus ( Electrical Drive Units @ $5 Each
New/Extended Feeders/Circuits Up to 200 A ( ) @$6 Each Luminaire Retrofit Modifications ( ) @ $. 25 Each
Feeders/Circuits Above 200A ( ) @ $15 Each Concrete-Encased Electrode Inspection ( ) @ $35 Each
Reconnected Feeders/Circuits ( ) @ $2 Each Investigative Fee $70 Or The Total Inspection Fee,
Whichever is Greater Up to $ 1,000
Manufactured Home Parlc Lot Supply ( ) @ $ 35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour
Plus [ ) Miles @ The IR5 Mileage Ra of )
Recreational Vehicle Site Supply Equipment ` /� d'E
( ) Circuits Originating in the Equipment @ $ 6 Each Other J�� 2
tJb
Street, Parking Lot, Lighting Standard ( ) @ $5 Each Over 600 Volts - Add the combined service/power supply and
feeder/circuit fee to result in double the regular fee (does not
apply to electric sign and outline lighting)
Transformers Up to 10 lwa ( ) @ $ 15 Each ( ) New Multi-Family Dwellings @ $ 70 Each
( ) State Surcharge of $ 5 . 00 t
( ) Additional Circuits Above the 20 Allowed r�
Per unit @ $6 Each
Transformers Over 10 lwa ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the ry
number of required inspection trips, whichever isgreater) Jam'
Receipt #
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
i
fft LT LDSIAN
iAEI Certified
Master Electrical Inspector
MINNESOTA DEPARTMENT OF
LAE30R US INDUSTRY
16275 Sheldon Ave.
Eden Prairie, MN 55344 Office flours 7:00-&30 a-m.
Tel. (952) 934-0229 Mon ,-Fri.
Order for Payment
i
Date Request for Z Inspection Serial Number Date Filed�01 3Y �i� Off
Electrical Contractor/lnstalier License Number
Owner/Occupant County
� / 0I12
Job Address - Street City wnship
This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection .
Fee Calculation/Explanation
Return this Order for Payment with your check payable to the in the
amount of $ _ by 1 (fourteen days from the date issued )
A service charge of $30 will be added for all dishonored checks.
Inspector Name and Number For Department Use Only
Inspector Telephone Number
Inspector ma' ddress ' e
Inspector Signature
i