HomeMy WebLinkAboutElectrical Permit 12. 186 Reset Form I Print Form J
For Office Use Only
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L ABOR & INDUSTRY
' ° Request for Electrical Inspection (REI) (permit)
443 Lafayette Road North
St. Paul, MN 55155 -4342 One- and Two - Family Dwellings
Phone: (651) 284 -5026
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. 05 -22 -2012
* Check One Box: IA Contractor or 111 Homeowner * Check One Box: es New Bldg or ❑ Existing Bldg
* Check One Box: F 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
14358 Parkside Court SCOTT
* Project Township: (Please enter only the township name * Project City: * Project Zip
or the city name, not both) Prior Lake
* Owner Name * Owner Phone Owner Cell Owner E -mail
Mattamy Homes
* Company Type (check one box)
0 Electrical Contractor ❑ Technology System Contractor
* Company License Number * Company Name
EA001432 Phase Electric
* Company Address * City * State * Zip Code
9929 Lyndale Ave S Bloomington MN 55420
* Company Phone Company Cell * Company E -mail Contact Person and Phone Number
(952) 881 -4100 michelle @phase- electric.com
* 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 p Yes or ❑ No
ID Will Schedule
Directions to Project Site
wire new home Project Site (Contact Person and Phone Number)
Electrical Utility
TOTAL INSPECTION FEE from REI fee worksheet, or $35 multiplied Enter Inspection Fee Here» * 135
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) 140
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 (651) 297 -4198.
Please submit RE forms together with the applicable fees to:
MN Dept Labor & industry, PO Box 64218, St. Paul, MN 55164 -0218
REI 10 (4/11) REI_10_OneAndTwoFamily.doc (Revised 4/1/11)