HomeMy WebLinkAboutElectrical Permit 12. 501 O 1 YRI
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44 CONTRACTOR /REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough -In Inspection Required? 0 Yes Inspection Other Than Rough -in: Ready Now
. 2 I 7I - I1, Contractor /Employer Must Schedule All Rough -In Inspections Contractor /Employer Must Schedule All Final Inspections
0 Will Schedule
Address of Inspection - Street Project Description:
4 Hwy /3 Trrocin ►art y 5 r? u2c
Owner Name G 'ti FOI - W7 CTQ, G.t'vER 6 " -
Owner Pho �G a2/701.10 Home: ��� 3V fb tb Cell: (fsa12) 22 to 969
Contractor /Registered Employer Name Contractor /Registered Employer Mailing Address
g (A -R l Lc E EL4""cr .Z_ c
Contractor /Employer?elephone Number Contractor /Employer E -mail Address Electrical Utility
Work 957. ''l�S �lo6z Ceii: 1„„i 7 $q Trebtour4s�..1 XGEL.+
Contractor /Employer Authorized Signature Contractor License Number Job /Protect Contact Person:
EXCXX ell or 6, o.-.) GAS - io�y
FEE CALCULATION
Service /Power Supply 0 -400 ampere @ $35 -jam r�,. Technology Systems Devices ( ) @ $ .75 Each
Service /Power Supply 401- 800 ampere @ $60 Separate Bonding Inspections for Swimming Pools and
_ Egulpotential Planes ( ) @ $35 Each
Service /Power Supply Above 800 ampere CO $100 Center Pivot Irrigation Booms ( ) @ $35 Each
New/Extended Feeders Circuits Up to 200 A Plus (, Electrical Drive Units @ $5 Each
New
/ / p ( ) @$6 Each 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 Park Lot Supply ( ) @ $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour
Plus ( ) Miles @ The f • S Mileage R of (. )
Recreational Vehicle Site Supply Equipment 041x, 7 "�`~ Lop) si-de)
( ) Circuits Originating in the Equipment @ $6 Each Other c oczct 7 r -
Street, Paridng Lot; Lighting Standard ( ) @ 55 Each Over 600 Volts - Add the combined service /power supply and
feeder /circuit fee to result in double the regular fee (does not
Transformers Up to 10 kva apply to electric sin and outline luting)
p ( ) @ $15 Each ( ) New Multi-Family Dwellings @ $70 Each
) State Surcharge of $5.00 1G y
(d Additional Circuits Above the 20 Allowed 3 .0
Per unit @ $6 Each
Transformers Over 10 kva ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the r ill -
number of required inspection trips, whichever is greater)
Receipt # 4, b 07 -�v 6
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The owner
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
Master Electrical Inspector
1 — 1 ( o ,�ti
MINNESOTA DEPARTMENT OF
LABOR & INDUJSTRY
16275 Sheldon Ave
Eden Prairie, MN 55344 Office Notts 7:00 -8:30 a.m
Tel. (952) 934-0229 Mon. Fri.
Order for Payment
Date Request for Inspection Serial Number Date Filed
/"" 12 -0 0 / /2 - 7 -/
Electrical Contractor/Installer License Number
BURNS ViLL &,EcTeerc, Efi 000 4' Z
Owner /Occupant County
c4 /N0k, CON5T (Ai GvoNA s c 077 -
J ((2$3( � /&13 Prr(ad4 L4f1<.,
This Order for Payment is for additional fees associated with the above referenced Request for Electrical inspection.
Fee Calculation /Explanation
Return this Order for Payment with your check payable to theaggINOMMINIftwm111111111e in the
amount of $ .- / • by (fourteen days from the date issued)
A service the .e of 530 will be added for all dishonored checks.
Inspector Name and Number For Department Use Only
inspector Telephone Number
Inspector mail Addres site
azei
inspector Signature