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HomeMy WebLinkAboutElectrical Permit 12. 184 Reset Form Print F orm For Office Use Only Amount of Check: as er: PermitTRAK / / Ask MINNESOTA DEPARTMENT OF ( (I) 0 ELE ! l 1 LABOR & INDUSTRY Request for Electrical Inspection (REI) (permit) 443 Lafayette Road North St. Paul, MN 55155-4342 One- and Two - Family Dwellings Phone: (6565 1) 284 -5026 026 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: 12 Contractor or ❑ Homeowner * Check One Box: 1151 New Bldg or ❑ Existing Bldg * Check One Box: © 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 1435ti 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) 2 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 Fi 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)