HomeMy WebLinkAboutElectrical Permit 12.504 .,0FPRIp
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MO. CONTRACTOR//REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough-In Inspection Required? ® Yes Inspection OtherThan Rough-in: Q Ready Now
I' t� U Contractor/Employer Must Schedule All Rough-In Inspections Contractor/Employer Must Schedule All Final Inspections
Q Will Schedule
Address of Inspection — Stre t 5-( Project Description:
Ow Name Y 1G U L
rM , e D ;
Owner Phone
Home: Cell: 5, -oR , - 77e( t
Contractor/Registered Employer Name Contractor/Registered Employer Mailing Address
`1 7 5& /y /s o- 5 + 1L} .
i N 5 S t a
Contractor/ mployer lelephone Number Contractor/Employer E-mail Address Electric Al Utility
Work: Cell : 95�r3— !� / _ 7 �( �5 j1,
i�1L ri i U f f U f �_ CIo i CGs �� X C e-
Contractor/EmployeWAuthogized ignature Contra or 11cen e N tuber Job/Project Contact Person:
CA 00 d 3 �. mot- ti :,, el -� n Imo:, >a 0 L7r .39
FEE CALCULATION
Service/Power Supply 0-400 ampere @ $35 Technology Systems Devices ( ) @ $ .75 Each
Service/Power Supply 401 - 800 ampere @ $60 Separate Bonding Inspections for Swimming Pools and
E ui otential Planes @ $35 Each
Service/Power Supply Above 800 ampere @ $ 100 Center Pivot Irrigation Booms ( ) @ $35 Each
Plus I Electrical Drive Units @ $5 Each
New/Extended Feeders/Circuits Up to 200 A (4f @$6 Each 1® Luminaire Retrofit Modifications ( ) @ $.25 Each
Feeders/Circuits Above 200A ( ) @ $15 Each Concrete-Encased Electrode Inspection ( ) @ $35 Each
Reconnected Feeders/Circuits ( ) @ $2 Each Investigative Fee $70 Or The Total inspection Fee,
Whichever is Greater Up to $1,000
Manufactured Home Par Lot�c Supply -( ) @ $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour
Plus ( I Milqs@ The LREMileagaAateoff
Recreational Vehicle Site Supply Equipment 3 v
( ) Circuits Originating in the Equipment @ $6 Each Otber Ar77(yi � �� t
Street, Parldng Lot, Lighting Standard ( ) @ $5 Each Over 600 Volts - Add the combined service/power supply and J
feeder/circuit fee to result in double the regular fee (does not
apply to electric si n and outline lighting)
Transformers Up to 10 kva ( ) @ $ 15 Each ( ) New Multi-Family Dwellings @ $ 70 Each
(`;pq State Surcharge of : r. 00
( ) Additional Circuits Above the 20 Allowed S
Per unit @ $6 Each
Transformers Over 10 kva ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the
number of re aired ins ection trips, whichever is eater
Receip€ # �p �] �' a � � Xr
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The owner 3 O
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
WALT LUSIAN
[AEI certified
soector
Master Electrical Irspector
A' LABOR INDUSTRY
16275 Sheldon Ave.
Eden Prairie, MN 55344 Office Hours 7:00-830 a.m.
Tel. (952) 934-0229 - Mon.-Fri.
Order for Payment
Date Request for Inspection Se ial Number Date Filed
/2 - 0,�0 � /2 - Z/- / 2
Electrical Contractor/Installer License Number
/1j,I) NTC, e
Owner/Occupant County
&/ kK1E L 5a /v 'S c.o Tl
Job Address - Street City ow��i2 / n
/ O AJ k K /W 1' /k This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection ,
Fee CalculationlExplanation
�ro ? yzL tl6/kE� Ir< aiia
UP To 30 cwwl Ts / 00 . °o
70, � b
L . -c�R- c. - 3 q L • gW 7 . 7138
Return this Order for PFyment with your check payable to the in the
amount of $ by (fourteen days from the date issued)
A service charge of S30 will be added for all dishonored checks.
Inspector Name and Number I For Department Use only
Inspector Telephone Number
Inspector E- mail AddressMe "te
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Inspector Signature