HomeMy WebLinkAboutElectrical Permit 12. 0042 c
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�/ U (f,i /v � e�j Amount of Check: Check Number: ./ PermitTRAK Number:
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LABOR Ex i; v Du: RY
443 Lafayette Road North Request for Electrical Inspection (REI) (permit)
St. Paul, MN 55155 -4342
Phone: (651) 284 -5026 Non - Dwellings and Multi - Family Dwellings
www.dli.mn.gov
Fields marked with an asterisk * are required (as applicable). * TODAY'S ATE
Incomplete, inaccurate, or illegible forms may be returned to the submitter. //2 / Z.
* Check One: Contractor or ❑ Registered Employer * Check One Box: ❑ New Bldg or xisting Bldg
* Check One Box: ❑ Multi - Family Dwelling or Oon-Dwelling (all projects other than dwellings)
* Permit Sub -Type (check one box)
❑ Agricultural ❑ Commercial ❑ Government ❑ Industrial Institutional ❑ Recreational ❑ Technology
* Project Location (number & street name) r. * Project County
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* Project Township: (Please enter only the township name * Project City: / * Project Zip
or th city name, not both) 1D, �f J. a ` t-- 5 _ 3 `7 2.
* Owner Name * Owner Phone Owner Cell Owner E -mail
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* C mpany Type (check one box)
Electrical Contractor ❑ Technology System Contractor ❑Registered Employer ❑ Class B Installer
* Company License /Registration No. * Company Nam
C 0 .4 4 iti/S Al "/4 -.- C --X
* Compan y Address_ * City * State * Zip Code & 5 —/----
* Company Phone / Company Cell * Company E fna Contact Person and Ph e Numbe
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* Project Description (Scope of work, service size, quantity of *Single Inspection *Rough in Inspection
feeders and circuits, job numbers, or other vital information to xO r than Rough -in? Required?
help the electrical inspector make timely inspection service) �I Ready Now or ❑ Yes or o
❑ Will Schedule
b lir6 h 7 7 "1 / 1'Cr 2 Directions to Project Site
di7 ) S d d.d.7 P ro . ct Site ( onta t Person and Phon
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Electrical Utility
TOTAL INSPECTION FEE from REI fee worksheet, or $35 multiplied
by the number of required inspection trips, whichever is greater. Enter Inspection Fee Here» * v
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) * V0,00
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