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Home My WebLink AboutElectrical Permit 12. 160 Reset Form Print Form For Office Use Only Amount of Check: Greek Number: PermitTRAK Number: MINNESOTA DEPARTMENT OF /'t.7 c'3'� ELE LABOR $t INDUSTRY A& Request for Electrical Inspection (REI) (permit) 443 Lafayette Road North S t . Phone: ( 65 1) 284 -5 P One- and Two - Family Dwellings hne: 65026 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. 11/02/2011 * Check One Box: 0 Contractor or ❑ Homeowner * Check One Box: ❑ New Bldg or F4 Existing Bldg * Check One Box: 0 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 * Pro' ct County /5A 1 /I ni Koa.1_, gi, * Project Township: (Please enter only the township name * Pr ect City: * Project Zip the city name, not both) 1r /0 k. n £ r (? / 9 9 *Owner Name * Owner Phone , Cell Owner E -mail Y.e n Jahn , 9J 2 -'76 * Company Type (check one box) 2 Electrical Contractor ❑ Technology System Contractor * Company License Number * Company Name EA001796 CENTERPOINT ENERGY * Company Address * City * State * Zip Code 9320 EVERGREEN BLVD NW SUITE B COON RAPIDS MN 55433 * Company Phone Company Cell * Company E -mail Contact Person and Phone Number (763) 785 -5404 joann .zinken @CenterPointEnergy.com JOANN ZINKEN 763- 785 -5404 * 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) E- Ready Now or ❑ Will Schedule ❑ Yes or I No & )17re /If t i (c,) / 4e.A4c 3 Directions to Project Site Project Site (Contact Person and Phone Number) Electrical Utility I TOTAL INSPECTION FEE from REI fee worksheet, or $35 multiplied Enter Inspection Fee Here » * by the number of required inspection trips, whichever is greater. /CO 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) * � 0,66 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 REI forms together with the applicable fees to: MN Dept Labor & Industry, PO Box 64227, St. Paul, MN 55164 -0227 REI 10 (4/11) REI_10_OneAndTwoFamily.doc (Revised 4/1/11) Request for Electrical MINNESOTA DEPARTMENT OF Inspection (REI) (permit) LABOR & INDUSTRY p ) 1p 443 Lafayette Road North St. Paul, MN 55155 -4342 Phone: (651) 284-5026 I nspection Fee Worksheet www.dli.mn.gov Item Description Quantity Fee Total * ** 0 to 400 Amp Power Source $ 35 /source 401 - 800 Amp Power Source $ 60 /source Over 800 Amp Power Source $ 100 /source 0 to 200 Amp Circuit or F $ 6/feeder r w .p..:. C. Feeder $ or circut Over 200 Amp Circuit or Feeder $ 15 /feeder or circuit New One- or Two - Family Dwelling (up to 30 circuits and feeders per unit) $ 100 /dwelling unit New One- or Two - Family Dwelling (additional circuits over 30 per unit) $ 6 /feeder or circuit Existing One- or Two - Family Dwelling (where 15 or more feeders or circuits $ 100 /dwelling unit are installed or extended per unit) Existing One- or Two - Family Dwelling (where less than 15 feeders or circuits $ 6 /feeder or circuit are installed or extended per unit) Reconnected Existing Circuit or Feeder (for panelboard replacements) a $ 2 /feeder or circuit Separate bonding inspection $ 35 /inspection Inspection of concrete - encased grounding electrode $ 35 /inspection Technology circuits & circuits less than 50 volts 75¢ /device or apparatus Additional inspection trip(s) $ 35 /inspection trip Investigative Fee (enter values in the Quantity and Fee columns) Other... Other... Other... Other... TOTAL INSPECTION FEE is the fee calculated above, or $35 multiplied by the number of required inspection trips, whichever is greater. Enter Inspection Fee Here & on REI » REI 10 (4/11) RED 0_OneAndTwoFamily.doc (Revised 4/1/11)