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HomeMy WebLinkAboutElectrical Permit 12. 415 Minnesota Department of Labor and Industry 443 Lafayette Road North St. Paul, MN 55155-4342 Phone: (651) 284 -5026 Permit Number www.dli.mn.gov /) — CJ {� i/i 3 Contractor Request for Electrical inspection Form v� TODA OAT Permit Type: Existing One- or Two- Family Dwelling (ELE EXST 1 OR 2 FAM) / 0 a 1 /z and Accessory Structures Pro rty /Job Site Address Site City Site Township Site County Site Zip Code "56>'S fr to ol..►+ Rd Se pc io( Let 14.-v S' S' 37 Z Owner Name er Phone Owner Celt Owner E -mail 144- Le, N a) 7/0 9 a 14 Company License/Registration Number Company Name Company Type (check one box) £A004780 MJ ELECTRIC MN INC E Electrical Contractor Company Address ' City State Zip Code ❑ Technology System Contractor 10731 UPTON AVENUE S BLOOMINGTON MN 55431 Company Phone Company Cell Company E -mail Company Contact Person and Phone Number (612) 598 -0793 (952) 888 -5616 mjelectric@comcast.net MIKE JOHNSON (952) 888 -5616 Permit Sub -Type (check one box) Project Short Description 5 Residential Existing to i < < IS 1 Aw Project Long Description Single Inspection Other than Rough -in? Rough -in Inspection Required? /� 1 `r' El Ready Now dl Schedule ❑ Yes �o W ( L L tb °1 Electrical Utility Job Site Contact Person Directions to Job Site 0 to 400 Amp Power Source ( ) © 335 > t . Tech Circuits & Circuits less than 50 Volts ( ) C 75¢ 401 - 800 Amp Power Source ( ) Q 360 Inspection Hourly Rate ( ) © 380 Over 800 Amp Power Source ( ) @ 3100 Inspection Mileage Rate ( ) miles @ 50¢ 0 to 200 Amp Circuit or Feeder ( ) © 36 Supplemental Fee ( ) © $35 Over 200 Amp Circuit or Feeder ( )@ $15 Reinspection Fee ( ) @ 335 Existing One - or Two - Family Dwelling (where more than 14 Investigation Fee (A minimum of 370. or equal to the total feeders or circuits are installed or extended) 3100 inspection fee. whichever is greater, not to exceed 31000) Existing One- or Two-Family Dwelling (where 14 or less feeders TOTAL FEE is the fee calculated above. or 335 multiplied by or branch circuits are installed or extended) ( ) @ S6lcrct the number of required inspection trips. whichever is greater. Reconnect Circuit or Feeder A surcharge of S5 is Imposed on every permit effective ( ) © 32 as per M.S. § 3268.148 35.00 i ' 0 0 Separate Bonding Inspection ( ) © $35 Grand Total CIO Insp of Concrete - encased Grounding Electrode ( ) @ 335 Requests for Electrical Inspection (REI) with a fee of 3250 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 one REI to another. A service charge of 330 will be added for all dishonored checks. I hereby certify that 1 inspected IM electrical installation herein on the dates stated: For Department Use Only T / y 67i/ 7 y Rou - In Inspection(s) Date � Final Inspection Date This material can be made available In different forms, such as largs print. Braille or on a tape. To request, call 1-800- 342-5364 (DUAL -OU) Voice or T00 (551) 2974198. REI 04 (7/10) REI 04 Contractor Exstlor2Family.doc (Revised 7/1/10)