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HomeMy WebLinkAboutElectrical Permit 12. 426 ik pia a (a Z3 ivi 4wE ' HOMEOWNER REQUEST FOR ELECTRICAL INSPECTION D e Rough -In Inspection Required? �es Inspection Other Than Rough -in: 0 Ready Now - 13 0._ Homeowner Must Schedule All Rough -In Inspections Homeowner Must Schedule All Final Inspections ISAill Schedule Address of Insppec ion --, Streett , f Project Description: � / (a2 f s�ln, h {c J am CO.. ± /V L. 61/1/ c..� K- L -fir j ✓ C.i 4 N Owner Name Yy1:cL R. 1 "- ) FjP.ec Owner Phone Home: 6 i.a — 356-9 ©. Cell: SANa 0 - 5 LovA -4 Owner Mailing Address (if different from above) Electrical Utility By signing this document, I certify that I am the owner as defined by Minn. Stat.325.01 and will legally perform the electrical work. Owner Signatur 2 EF E CALCULATION New Home or Associated Structure Existing Home /Structure Remodel or Addition New Home Service /Power Supply 0 -400 ampere @ $35 New Home Service /Power Supply 0 -400 ampere @$35 New Home Service 401- 800 ampere @ $60 New Service /Power Supply 401 -800 ampere @ $60 New Home Feeders /Circuits New /Extended Feeders /Circuits Up to 15 Feeders /Circuits ( ) Up to 30 Feeders /circuits $100 Feeders /Circuits @ $6 Each or 16 to 30 New Home - More than 30 Feeders /Circuits (in addition to above New /Extended Feeders /Circuits - More than 30 Feeders/ ( ) Feeders /Circuits up to 200A @ $6 Each Circuits ( ) Feeders /Circuits Up to 200 A @ $6 Each Other (Specify) Reconnected Feeders /Circuits ( ) @ $2 Each Manufactured Home Park Lot Supply ( ) $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour Plus ( ) Miles The IRS Mi age Rate of ( ) Detached Garage or Other Associated Structure Detached arage or thet Associated Structure New Home Service /Power Supply 0 -400 ampere @$35 New Home Service /Power Supply 0 -400 ampere @ $35 New Feeders /Circuits ( ) @ $6 Each New /Extended Feeders /Circuits ( ) @ $6 Each Other (Specify) Reconnected Feeders /Circuits ( ) @ $2 Each Other (Specify) State Surcharge = $5.00 S TOTAL (the fee calculated above or $35 multiplied by the TOTAL (the fee calculated above or $35 multiplied by the 75— number of required inspection trips, whichever is greater) number of required inspection trips, whichever is greater) Receipt # (t2 76, Z-D '4 110 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 Certifted .. Master Electrical Inspector MINNESOTA DEPARTMENT OF ----:4, LABOR et i NDUSTRY 16275 Sheldon Ave. Eden Prairie, MN 55344 Office Hours 7:00-8:30 a.m. Tel. (952) 934-0229 Mon.-Fri. Order for Payment tirtesinsmaanmengsnamima. - inwift - • Date Request for Inspection Serial Number Date Filed //-43 -/ Electrical Contractor/Installer License Number N R Owner/ cupant County 6 5 co Er Job Address - Street ler ownship /C26, M fi AitC4 C. T. < P,VaRi Z.1.C. This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection. Fee Calculation/Explanation 44 Arf 04b277770A/19Z //Y-9'277e7Y _S ---. (2 770774 - 4-- ) • • Return this Order for Payment with your check payable to the in the --cat amount of $ ---' by fAVT: , (fourteen days from the date issued) A service charge of S30 will be added for all dishonored checks. Inspector Name and Number For Department Use Only Inspector Telephone Number e l Inspector E-m l 1 Address/7 ec( Insp or Signature