HomeMy WebLinkAboutElectrical Permit 12. 428 'Rom, , '
For Office Use Only
Amount of Check: Check Number: Perm1tTRAK Number:
MINNESOTA DEPARTMENT OF
ELE 1- d
- BOR INDUSTRY
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411‘ Request for Electrical Inspection (REI) (permit)
443 Lafayette Road North
St. Paul, MN 55155 -4342 One- and Two-Family Dwellings
Phone: (651) 284 -5026 Y
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. 11 -12 -2012
* Check One Box: 12 Contractor or ❑ Homeowner * Check One Box: ❑ New Bldg or K2 Existing Bldg
* Check One Box: E I 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
13953 Kensington Avenue NE SCOTT
* Project Township: (Please enter only the township name * Project City: * Project Zip
or the eity name, not both) Prior Lake 55372
* Owner Name ' * Owner Phone ' Owner Cell Owner E -mail
Milan Hart (952) 564 -0250
* Company Type (check one box)
2 Electrical Contractor ❑ Technology System Contractor
* Company License Number * Company Name
EA001027 Herb Kohn Electric Company
* Company Address * City * State * Zip Code
3230 Gorham Avenue, Suite 2 Saint Louis Park MN 55426
* Company Phone Company Cell * Company E -mail Contact Person and Phone Number
(952) 929 -2648 (952) 994-9764 lynnae @kohneiectric.net Lance 952- 994 - 9764
* Project Description (Scope of work, service size, quantity of *Single Inspection *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) ❑ Ready Now or
CI Will Schedule
El Yes or No
Directions to Project Site
Install receptacle /circuit for garage heater only. Project Site (Contact Person and Phone Number)
Lance 952 - 994 -9764
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 REI forms together with the applicable fees to: k 7 /p,3 t
MN Dept Labor & Industry, PO Box 64218, St. Paul, MN 55164 -0218
REI 10 (4/11) REI_10_OneAndTwoFamily,doc (Revised 4/1/11)