HomeMy WebLinkAboutElectrical Permit 12. 500 •
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NErt:-' CONTRACTOR /REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough -ln Inspection Required? 0 Yes Inspection Other Than Rough -in: 0 Ready Now
/ 2. -18-0-- Contractor /Employer Must Schedule All Rough -In Inspections Contractor /Employer Must Schedule All Final Inspections
e10 rSchedule
Ac�drGss I / ectio 7 Str / a Project Description:
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Owner Na �� ✓ it 1 l Pi l �t . �-�i' / ' f'l c+ C� •
Owner Phone xr ` '' C- H r3
Home: �
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Contractor /Registered Emplo er Name C. ntra /or •egistered Emp oy Mailing Address. _, F Au 6-all"‹....1-
i A co 7 ,6, ildt c 14 el . ' c t p - t , ,5 rt A - 4 +v■ 6- Contractor /Employer Telephone N ber / Contractor /Employer E -mail Address l � l . v •I Electrical Utility /
Work: / �� f� ll: ? 66 t 0 h KA-J ( C 57 T�
c• ■trac .r ,• .yer Au -- .• ized Signature Co tra for License Number Job /Project •ntact Person: __, -,/ / 4 .1..
1/„. 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
Egaipotential Planes ( ) @ $35 Each
Service /Power Supply Above 800 ampere @ $100 Center Pivot Irrigation Booms ( ) @ $35 Each
P .s Electrical Drive Units @ $5 Each
New /Extended Feeders /Circuits Up to 200 A ( '.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 Park Lot Supply ( ) @ $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour
, PIus ( ) Miles @ The IRS Mileage Rate of ( ) _
Recreational Vehicle Site Supply Equipment
( ) Circuits Originating in the Equipment @ $6 Each Other
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Street, Parking Lot, Lighting Standard ( ) @ $5 Each Over 600 Volts - Add the combined service /power supp nd
• feeder /circuit fee to result in double the regular fee (does not
apply to electric sign and outline lighting)
Transformers Up to 10 kva ( ) @ $15 Each ( ) New Multi - Family Dwellings .@ $70 Each
() State Surcharge of $5.00 5
( ) Additional Circuits Above the 20 Allowed
Per unit @ $6 Each
Transformers Over 10 kva ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the
`1 (
number of re fired inspection trips, whichever is greater) '1rj
P O -�T C> C�j . '''& i i i 3 /3 Receipt # 27 -..6,
Requests for Electrical Inspection (REI) with a fee of $250 0 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 - Inspection (s) Date WaltLusian, Electrical Inspector
952.934.0229
Final Inspection Date
WALT LUSIAN
IAEI Certified
Master Electrical Inspector
MINNESOTA DEPARTMENT OF
LABOR & INDUSTRY
16275 Sheldon Ave.
Eden Prattle. MN 55344 Office Hours 7:00 -8:30 a.m.
Tel. (952) 934-0229 Mon: Fri.
Order for Payment
Date Request for inspection Serial Number Date Fled
/2 - 31- /2 n -c, OP /Z - /Y•I 2
Electrical Contractor /Installer License Number
GTIUN Eic lC/ e_.. Er9W 7 6
O r /Occup t County
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Job Address - Street ownship
This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection.
Fee Calculation/Explanation
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Return this Order for Payment with your check payable to the in the
amount of by (fourteen days from the date issued)
A service charge of $30 will be added for all dishonored checks.
Inspector Name and Number For Department use Only
inspector Telephone Number
Inspector E -mai Address/WW
t nspect or ignature