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HomeMy WebLinkAboutElectrical Permit 12. 421 Re fore Fat itr.. . d1 or:Office.Use Only Amount of Check: cheek' Nuumber PermItTRAK Number: • MINNESOTA DEPARTMENT lf/ ELE !. . L ABOR 3c INDUSTRY - rO85a1 443 Lafayette Road North Request for Electrical Inspection (REI) (permit) St. Paul, MN 55165.4342 Phone: (661) 284 -5026 Non - Dwellings and Multi - Family Dwellings www.dii.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. 10 -16 -12 * Check One: 112 Contractor or ❑ Registered Employer * Check One Box: ❑ New Bldg or ❑ Existing Bldg * Check One Box: ❑ Multi- Family Dwelling or 121 Non - Dwelling (all projects other than dwellings) * Permit Sub -Type (check one box) ❑ Agricultural 121 Commercial ❑ Government ❑ Industrial ❑ Institutional ❑ Recreational ❑ Technology *;Project Location (number & street name) * Project County 16800 Duluth Ave. SE SCOTT ". : Project.Township (Please enter only the township name * Project City:. . . * Project Zip or the cltvname, not both) Prior Lake 55372 * Owner Name * Owner Phone Owner Cell Owner E - mail Holiday #198 (952) 830 - 8839 *: ,Company:Type(checkonebox) ::.:.:..::..:....::..:::::.. ; ...:; :.:... • ,., ..:.:,, ...;.....- :..:....: •_, ,'..,:..:.:, :. ;:......:..:,.. ;: ,.;: Electrical Contractor: ❑ Technology System Contractor ; � 0 .Registered Employer . ❑ Class B Installer * Company. License /Registration No *: Company Name EA0035.73 Parsons Electric * Company Address * City * State ..:.. * Zip Code 59 Minneapolis : ; MN 55432 . * Company Phone Company Cell * Company E -mail : • Contact Person and Phone. Number `(763):57.1.800c) service- electrical©parsonscorp.com Smut S117y €_ " lob-311-2000 * 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 ❑ Yes or ra No Will Schedule Directions to Project Site NEMA L6 -20p dedicated connection as for VIPER frozen beverage units. Install small buck boost with receptacle. Project Site (Contact Person and Phone) Relocate condiment and add VIPER. 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 Feekao Requests for Electrical inspection (REI) with a fee of 8250 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 materiel 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: MN Dept Labor & Industry, PO Box 64218, St. Paul, MN 55164 -0218 REI 11 (4/11) REI_ 11_ MultiFamilyAndNonDwellings .doc(Revised 411/11)