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HomeMy WebLinkAboutElectrical Permit 12. 0060 Minnesota Department of Labor and Industry ��v �� St. 443 Lafayette Road 3A2 / ��� �, � a *. " 5 ?�' 7 St. Paul, MN 55155 4342 `-'� Phone: (651) 284 -5026 Permit Number www.dli mn.gov / Z -- ‘,0 0 Contractor Request for Electrical Inspection Form TODAY'S D Permit Type: Existing One- or Two- Family Dwelling (ELE EXST 1 OR 2 FAM] P rp ,t I', Zo /Z and Accessory Structures erty /Job Site Address Site City Site Township Site County Site Zip Code - K )-ox 4-Al 4,r4,\ Prr t _: k_., S S 7 L Owner Name Owner Phone Owner Cell Owner E -mail $ /k) (-t 6sl Z `o-'t` Company License /Registration Number Company Name Company Type (check one box) CA 04780 MJ ELECTRIC MN INC E Electrical Contractor Company Address City State Zip Code ❑ Technology System Contractor 10731 UPTON AVENUE S BLOOMINGTON MN 55431 Company Phone 1 Company Cell ( Company E - mail Company Contact Person and Phone Number (612) 598 - 0793 1(952) 888 - 5616 Imjelectric @comcast.net MiKE JOHNSON (952) 888 - 5616 Permit Sub -Type (check one box) Project Short Description I 12 Residential Existing S , �- it `4�/ C Project Long Description Single Inspection Othir than Rough Rough - in Inspection Required? ❑ Ready Now ❑ Will Schedule ❑ Yes ❑ No 5 ' ; 10 .� ?i ° � t G Electrical Utility Job Site Contact Person 2 • A.,)-- S ' G-' l Directions to Job Site 0 to 400 Amp Power Source ( ) @ $35 Tech Circuits & Circuits less than 50 Volts ( ) @ 75¢ 401 - 800 Amp Power Source ( ) @ $60 Inspection Hourly Rate ( ) @ $80 Over 800 Amp Power Source ( ) @ $100 Inspection Mileage Rate ( ) miles @ 50¢ 0 to 200 Amp Circuit or Feeder ( ) @ $6 Supplemental Fee ( ) © S35 Over 200 Amp Circuit or Feeder ( ) @ $15 Reinspection Fee ( ) @ $35 Existing One or Two Dwelling (where more than 14 Investigation Fee (A minimum of $70. or equal to the total feeders or circuits are installed or extended) $100 inspection fee. whichever is greater, not to exceed $1000) Existing One- or Two-Family Dwelling (where 14 or less feeders TOTAL FEE is the fee calculated above, or $35 muiiipiied by or branch circuits are installed or extended) ( ) @ $6/crct the number of required inspection trips. whichever is greater. A surcharge of $5 is imposed on every permlt effective $5.00 Reconnect Circuit or Feeder ( ) @ $2 7/1/10 as per M.S. § 3268.148 y Separate Bonding Inspection ( ) @ $35 Grand Total i t C' Insp of Concrete-encased Grounding Electrode ( ) @ $35 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 one REI to another. A service charge of $30 will be added for all dishonored checks. I hereby certify that I inspected the electrical installation herein on the dates stated. For Department Use Only Rough - In Inspection(s) Date Final Inspection Date This material can b• made available in different forms, such as large print, Braille or on a tape. To request, call 1 -$00- 342$364 (DUAL -OU) Voice or T0D (651) 297.4198. REI 04 (7/10) REI 04 Contractor Exstlor2Farnily.doc (Revised 7/1/10)