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HOP# E OWNER R E QUEST FOR ELECTRICAL IISPEC 'TION
Date Rough-In Inspection Required ? es Inspection Other Than Rough-in : O Ready Now
Homeowner Must Schedule All Rough-In Inspections Homeowner Must Schedule All Final Inspections Q Will Schedule
Address of Inspection — Street Project Description :
YJGI Ir # 44Wt 6401 40V A/1% 441ke i%V 6972
Owner Name
Owner Phone
Home: v S 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. 325.01 and will legally perform the electrical work.
Owner Signature • G/�, _
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 0400 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 0400 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 S
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 is eat number of required inspection trips, whichever is eater
Receipt # `j Zo I/C7
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The ow er
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
I
PRr® RECEIPT # 68861
Ve CITY OF PRIOR LAKE
*� 4646 DAKOTA STREET S . E .
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—� -� � PRIOR LAKE, MN 55372 104
U �k (952) 447 -9800 , FAX (952) 4474245 DATE :
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Total Receipt Clerk for : e City of Prior Lake
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14368 BROOKMEREBtVO NW jj 20 722
PRIOR LkE;: MN
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