HomeMy WebLinkAboutElectrical Permit 12. 495 ki 10
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:KEsotr' CONTRA CTOR/ R I-0 G STER FED EMPLOYER R b QU 1a 5 ll FOR
ELECTRICAL RIMSP E CTION
Date Rough-In Inspection Required? Q Yes Inspection Other Than Rough-in : Q Ready Now
j /3A Contra ctor/Employer Must Schedule All Rough-In Inspections Contractor/Employer Must Schedule All Final Inspections
ill Schedule
Address of Inspection — Street ?65 7 ��� � V J�f project Description: a
Owner Name 10!v& 7z
Owner Phone
Home: Cell :
Contractor/Registered Employer Name Contractor/Registered Employer Mailing Address'
4�4 f 1, W
Contractor/Employer Telephone Number Contractor/Employer E-mail Address �,. y �/t t Electrical Utility
Work: F,�Z ZI� � ►O ! lml
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Contractor/E o r A thorized Signature Contractor License Number Job/Project Contact Person :
L=W0Z73 � a �
,A E 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 otentialPlanes @ $35 Each
Service/Power Supply Above 800 ampere @ $100 Center Pivot Irrigation Booms ( ) @ $35 Each
Plus Electrical Drive Units @ $5 Each
New/Extended Feeders/Circuits Up to 200 A ( ) @$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 U to $1,000
Manufactured Home Park Lot Supply ( ) @ $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour
Plus Miles @ The IRS Milea a Rate of
Recreational Vehicle Site Supply Equipment
( ) Circuits Originating in the Equipment @ $6 Each Other
Street, Parking Lot, Lighting Standard ( ) @ $5 Each Over 600 Volts — Add the combined service/power supply and
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
[ ) 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 n
number of required inspection trips, whichever is greater) V
Receipt # 0 7 721
Requests for Electrical Inspection (RRI) with a fee of $2 i0 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 worts. Inspection fees do not carry over from one RII 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 , Eiecirical Inspector
952 . 934. 0229
Final Inspection Date
WALT LUSIAN
IAEI Certified
Master Electrical Inspector
Y MINNESOTA DEPARTMENT OF
L.AIBOR INDUSTRY
16275 Sheldon Ave.
_den Prairie, MN 55344 Office Hours 7:00-8:30 a.m.
Tel . (952) 934-0229 Mon.-Fri .
Order for Payment
Date � Request for Inspection S I Number Date Filed
electrical Contractor/Installer License Number
� 51N EL6crikI C
caner/Occupant County
7 U
Job Address - Street City o lnship
O4: UVI) v �r Frio GX/< I F�
This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection .
Fee CalculationlExplanation
F,esfi 3 � 0TS
Go
00
AUNT Q� J2j 13L
Return this Order for Payment
yent 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 �ddr ebsite
Inspector Signature