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Home My WebLink AboutElectrical Permit 12. 0119 o�_ raro� Ir' VLJI AV U m °Poe CONTRACTOR/ REGISTERED EMPLOYER REQUEST FOR ELECTRICAL INSPECTION Date Rough-In Inspection Required? es Inspection Other Than Rough-in : Q Ready Now Contractor/Employer Must Schedule All Rough-In Inspe tions Contractor/Employer Must Schedule All Final Inspections ill Schedule Address of Inspection — Street Project Description : Owner Name & �, G Owner Phone Home: Cell : Contractor/Re istered Employer Name Contractor/Registered Employer Mailing Address Contractor/Employer Telephone Number Contractor/Employer E-mail Address Electrical Utility Work: Cell: Contractor/Emplo r Authorized Signature Contractor License Number Job/Project Contact Person : FEE CALCULATION 77 3 � Service/Power Supply 0400 ampere @ $35 Technology Systems Devices ( ) @ $ .75 Each Z tNsD Zl�i O Service/Power Supply 401 — 800 ampere @ $60 Separate Bonding Inspections for Swimming Pools and E ui otential 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 Park Lot Supply ( ) @ $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour Plus Miles @ The IRS Milea a Rate of Recreational Vehicle Site Supply Equipment ( ) Circuits Originating in the Equipment @ $6 Each Other 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 kva ( ) @ $15 Each ( ) New Multi-Family Dwellings @ $70 Each ( ) State Surcharge of $5.00 G ( ) Additional Circuits Above the 20 Allowed Per unit @ $6 Each Transformers Over 10 kva ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the number of required inspection trips, whichever is greater) Receipt # S � / 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 errvice�charge of $ 28 will be added all disho or Jr : c cks c�� / I hereby certify that I inspected the electrical installation herein on the l dates stated : Rough- In Inspection (s) Date Walt Lusian , Electrical Inspector 952 . 934 . 0229 Final Inspection Date '43D . 00ta,,OLW� k .ILA Y✓ Aee Order for Payment Date Filed v Request for Inspection Serial Number Date Lk ens CA 0 ry � Electrical Contrar/lnstalle U C county � �r � l & J ( ( Owner/OccuQa � ci ownshi/pl Job Address - Street 1111Lj �!� U ection * f� G✓Q �� Request for Electrical Insp payment is for additional fees associated with the above referenced This Order for v lanatllo Fee CalculationlExp O in the Payment wAMEM ith your check payable to the Return this Order for 0 (fourteen days from the date issued) by amount Of For Department Use Only A service charge of $30 will be added for all dishonored chec s. Inspect r Name and Number n J Inspec4tor Telephone Numbed 22 Inspector E-mail AddresslWebsite Inspector S' natur _— - - - - �OF PRIp� � !' i 6ti6VJ11� .e Z lr - U trt HOMEOWNER REQUEST FOR ELECTRICAL INSPECTION Date Rough- In Inspection Required ? Q Yes Inspection Other Than Rough-in : Q Ready Now � � �` �� Homeowner Must Schedule All Rough- In Inspections Homeowner Must Schedule All Final Inspections Q Will Schedule Address of Inspection - Street Project Description : Owner Name 0,GJ Owner Phone G Home : �� '-?�?(� - �g �'p Cell : Owner Mailing Address (if different from above) Electrical Utility 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 isgreater) number of required inspection trips, whichever isgreater) �s Receipt # 6? 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