HomeMy WebLinkAboutElectrical Permit 12. 221 10 spRiO4 I I f _ .� -.- .. �_ ga CONTRACTOR /REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough -1n Inspection Required? • Yes Inspection Other Than Rough -in: 0 Ready Now
II -- QQ Contractor /Employer Must Schedule All Rough -In Inspections Contractor /Employer Must Schedule All Final Inspections
tD — �O ` p • Will Schedule
Address of Inspection — reet Project Description:
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Owner Name C
Owner Phone
Home: Cell: _
Contractor /Registerddl � iecfric Services Contractor /Registered Employer Mailing Address
1600 C Rd. 10 NI-
C ni o y er T leph L
ee No Park, Contra oyer E -mail Address Electrical Utility
p t j ge ,C e P �, MN
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Contractor /Employer Autho( Q.ei tJe83"7u8Qtractor 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
Egpipotential 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 (le) @$6 Each Luminaire Retrofit Modifications ( ) @ $.25 Each
C ,CXa
Feeders /Circuits Above 200A ( ) @ $1S Each Concrete- Encased Electrode Inspection ( ) @ $35 Each
Reconnected Feeders /Circuits (5) @ $2 Each l o v 0 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 Mileage Rate of ( )
Recreational Vehicle Site Supply Equipment
( ) Circuits Originating in the Equipment @ $6 Each Other ' �'aU Spy Cl) Ft. - �D - E_ 3
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
( ) 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) /
/4 At SPEn),✓ 3 �' ,�Gtfa/ ` 576 Receipt # Isar,
• /C
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
.0�, Vill° RECEIPT 66576
e CITY OF PRIOR LAKE
'7 4646 DAKOTA STREET S.E.
I-., x PRIOR LAKE, MN 55372
U tri (952) 447 -9800, FAX (952) 447 -4245 DATE: 7/36//2--
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Received of /( . & s - A4A,A-r .r 1 /
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for the purpose of / , / t -e-t :-C , X - cto - Y•- -' `.
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Payment
El Cash
Invoice #
Ei Check ..3S - 6 0
Q ACH
Total OS, 0 6 Rec pt Clerk for the City of Prior Lake
` i_.S i S Cmo%- 4-1 11733
A. E. M. ELECTRIC SERVICES �Q �
1600 COUNTY HIGHWAY 10 NE C3 376` , -'2 :1 O'C1O
SPRING LAKE PARK, MN 55432
(763) 783 7080 t'r) O � � oy, --a L ._ l a 17.2 -910
1 TO THE - 1a -aa 35. 00
ORDER OF _ A • — - •
1 r 3 JVh _ V \C---' � DOLLARS o ,,o
t U F OR AMOUNT
IRED AMOUNTS OVER $500.00
bank. of M ser 0-)e \ .8 /1.-wi•-'4"----
FOR rl!(Y \).Jl. L "' cDa 1 V \ -(71
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