HomeMy WebLinkAboutElectrical Peremit 12. 0047 -0 ' I'-I I oc, 1
Mi . -J ;ta Dep' ' rrtent of Labor and Industry / f /,, 7,
443 = ayette °'oad North l L , �� - 1A. ()sr 1.-A1� E_ �.t �/7 1"�
St. Paul, • ■ ■ 55155 -4342 r
Phone: (• 1 ' : Permit Number if? 7
www.dli n.gov i
Contractor or Registered Employer Request for Electrical Inspection Form
TODAY'S DATE, Permit Type: all electrical work other than dwellings (ELE NON - DWELLING)
Property /Job Site Address S.0 City , Township Site County Site Zip Code
i h 6) -- t, l - 1 (3 5 t, n i- i---s , --t 5 i in I," ; 7
Owner Name Owner Phone Owner Cell Owner E -mail
t \ i A 5 -- fit, t 1 t-"tr - _J 44-16 ' - 17' —
Company License /Registration Number Company Name _ Company Type (check one box) ,
g Electrical Contractor
r. State Zip Code Technology System Contractor
Company Address City f El Registered Employer
i � �'� �"�"- ,} 5S2 OA \ 71Y) 3 7 � ❑ Class B Installer
Company Phone Company Cell Company E -mail Company Contact Person and Phone Number
Permit Sub -Type (check one box)
❑ Agricultural ❑ Commercial ❑ Government ' Industrial ❑ Institutional ❑ Recreational ❑ Technology
Project Short Description Project Long Description en C-Ce
`
Single Inspection Other than Rough-in? ` Rough -in Inspection Required?
❑ Ready Now X Will Schedule ❑ Yes IS4 No
Electrical Utility Job Site Contact Person Directions to Job Site
0 to 400 Amp Power Source ( r 1) ) @ $35 ' 7 C Street; Parking Lot, Outdoor, Traffic Standards ( ) @ $5
401 - 800 Amp Power Source ( ) @ $60 Transformer Light Heat & Power up to 10KVA ( ) @ $15
Over 800 Amp Power Source ( ) @ $100 Transformer Light Heat & Power over 10KVA ( ‘ ) @ $30 3,_:
0 to 200 Amp Circuit or Feeder ( ` t ) @ $6 1 Power Supplies for Signs & Outline Lighting ( ) @ $5
Over 200 Amp Circuit or Feeder ( 1 ) @ $15 i, 5 Tech Circuits & Circuits less than 50 Volts ( ) @ 75¢
Reconnect Circuit or Feeder ( (c,LI ) @ $2 i i Center Pivot Irrigation Booms ( ) @ $35
Separate Bonding Inspection ( / ) @ $35 Center Pivot Irrigation Drive Units ( ) @ $5
Insp of Concrete - encased Grounding Electrode ( ) @ $35 Retrofit of Existing Lighting Fixtures ( ) @ 25¢
0 to 400 Amp Power Source over 600V ( ) @ $70 Inspection Hourly Rate ( ) @ $80
401 - 800 Amp Power Source over 600V ( ) @ $120 Inspection Mileage Rate ( ) miles @ 500
Over 800 Amp Power Source over 600V ( ) @ $200 ; Supplemental Fee ( ) @ $35
0 to 200 Amp Circuit or Feeder over 600V ( ) @ $12 , Reinspection Fee ( ) @ $35
Investigation Fee (A minimum of $70, or equal to the total
Over 200 Amp Circuit or Feeder over 600V ( ) @ $ inspection fee, whichever is greater, not to exceed $1000)
TOTAL FEE is the fee calculated above, or $35 multiplied by
Reconnect Circuit or Feeder over 600V ( ) @ $ the number of required inspection trips, whichever is greater.
A surcharge of $5 is imposed on every permit effective $5.00
Manufactured Home Park Lot Supply ( ) @ $35 7/1/10 as per M.S. § 326B.148 a _ _ s
__ z
Recreational Vehicle Site Circuits ( ) @ $6 ____ __ __� -�� Grand Total � �—
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 ce charge of inspection n w
fee
e o added for all dishonored Ins ection fees do not carry over from one REI to another.
A service
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 be made available in different forms, such as large print, Braille or on a tape. To request, calf 1 - 342 - 5354 (DIAL - DLI) Voice or TDD (651) 297 - 4198.
REI 07 Contractor Non Dwelling.doc (Revised 7/1/10)
REI 07 (7/10)