HomeMy WebLinkAboutElectrical Permit 12. 0036 Citl cf-- p Reset Form I Print Form
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MINNESOTA DEPARTMENT OF . (JCS 932_ / ELE /Z- .3(e,
LABOR 84 INDUSTRY" /29„e// otr (,• ) c/ - %
Request for Electrical Inspection (REI) (permit)
443 Lafayette Road North
St. Paul, MN 55155 -4342 One- and Two - Family Dwellings
Phone: (651) 284 -5026
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. 1/17/2012
* Check One Box: W 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) * Project County
4805 Dakota Street _ SCOTT
— ------ - - - - -- - -- — - -- -------------- - - - - -- -- - - - - -- - - -- — * Pr oject City: * Project Township: (Please enter only the township name 1 y * Project Zip
or the city name, not both) Prior Lake 55372
* Owner Name * Owner Phone Owner Cell Owner E -mail
Tom Flink (952) 447 -5286
* Company Type (check one box)
0 Electrical Contractor ❑ Technology System Contractor
* Company License Number * Company Name
CA06158 Mister Sparky Electric
* Company Address * City * State * Zip Code
1904 Vermillion Street Hastings MN 55033
* Company Phone Company Cell * Company E -mail Contact Person and Phone Number
(651) 437 -4177 tiffany.gorman @onehourair.com Tiffany Gorman 651 - 437 - 4177
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le Inspection • Project Description (Scope of work, service size, quantity of *Sing 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) 1151 Ready Now or ❑ Yes or 161 No
❑ Will Schedule
Directions to Project Site
Replacement wiring of Rooftop Ac and Furnace Project Site (Contact Person and Phone Number)
Electrical Utility
TOTAL INSPECTION FEE from REI fee worksheet, or $35 multiplied Enter Inspection Fee Here » * 35
by the number of required inspection trips, whichever is greater. ,
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) 40
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 RE] forms together with the appficable fees to
MN Dept Labor & Industry, PO Box 64227, St. Pau, MN 55164-0227
REI 10 (4/11) REI_10_OneAndTwoFamily.doc (Revised 4/1/11)