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HomeMy WebLinkAboutElectrical Permit 12. 412 „ � 1.3 rn a - LANES° HOMEOWNER REQUEST FOR ELECTRICAL INSPECTION Date Rough -In Inspection Required? Q Yes Inspection Other Than Rough -in: 0 Ready Now oceA 3 ` 1 Cot 2_ Homeowner Must Schedule All Rough -In Inspections Homeowner Must Schedule All Final Inspections Q Will Schedule Address of Inspe on -Street r . K)..._ Project Description: 4 .10 1 6 7 S cAle.r rt,� Kr, �cK)..._ /6 ctp m.- I-..x�*�r' r'h % a c 2l.R Owner Name ` J N Owner Phony Home: Cr as kQ^ 0 Cell: to IA -c1'7 )1-- 3C( 5 Owner Mailing Address (if different from above) U Electrical Utility By signing this document, I certify that I am the o ;. er as defined by Minn. Stat.325.01 and will legally perform the electrical work. Owner S' ature _ - , FEE 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) 2 (N e i ?j� "Z ©, -- Reconnected Feeders /Circuits ( ) @ $2 Each SA. Manufactured Home Park Lot Supply ( ) $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour Plus ( ) Miles @ The IRS Mileage Rate of ( ) Detached Garage or Other Associated Structure Detached Garage or Other Associated Structure New Home Service /Power Supply 0 -400 ampere @$35 I New Home Service /Power Supply 0 -400 ampere @ $35 New Feeders /Circuits ( ) @ $6 Each New /Extended Feeders /Circuits ( ) @ $6 Each Pfrlik PEA Keel 3) I Other (Specify) L y/� �j 2 Reconnected Feeders /Circuits ( ) @ $2 Each -e(n)C(o� C' ��� , 35 ” Other (Specify) ' State Surcharge = $5.00 s_-- TOTAL (the fee calculated above or $35 multiplied by the TOTAL (the fee calculated above or $35 multiplied by the number of re' uired ins • ection tri . s, whichever is • reater number of rev uired ins. ection tri i s, whichever is greater) ‘� 7. ti ( 1 /Ec b tt ( 33' X61 CA Receipt # (0 7443 114' "( 2 21( 7- gilt.) Sll+$Cte^r Oc 4 35- - R' �- t'il'.'1(!l-* 17-1 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 - Inspection (s) Date Walt Lusian, Electrical Inspector 952.934.0229 Final Inspection Date WALT LUSIAN IAEI Certified Master Electrical Inspector 't- MINNESOTA DEPARTMENT OF LABOR & INDUSTRY P 6tr 5 2-- q \d 4- 1 2 - 4 (Z- 16275 Sheldon Ave. I Z - 4- E Eden Prairie, MN 55344 Office Hours 7:00 -8:30 a.m. Tel. (952) 934 -0229 Mon.-Fri. Order for Payment Date / --‘-/' Request for Inspection Serial Number Date Filed tZ- 4-17--- /O 3/ -- / 2 - Electrical Contractor /Installer License Number Owner /Occupant County 17 5 ca77 Job Address - Street it 'ownship �7 lerff/�g /Witt er RI r°/r/o m /s ue This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection. Fee Calculation /Explanation 06 ■ - /N5e O. tip t- ( - ` (/ .lJ v/ 00 k 'V ‘v• • yc) • , 60 0 l to\ de 4c 6 74-11:1/411 4 V 1P Return this Order for Payment with your check payable to the in the amount of $ 3,5"" by rif /D (fourteen days from the date issued) A service charge of 830 will be added for all dishonored checks. Inspector Name and Number For Department Use Only Inspector Telephone Number Inspector E -mail AddresslWe ite Inspector Signature (Lit --:::"?It: is I ft,. . , i . k ' . 04 --c. . • 4 \''''' 4 goi, lire, # 4 kt ->p4.,:" WALT LUSIAN IAEI Certified Master Electrical Inspector MINNESOTA DEPARTMENT OF L ABOR & INDUSTRY 16275 Sheldon Ave. Eden Prairie, MN 55344 Office Hours 7:00 -8:30 am. Tel. (952) 934 -0229 Mon.-Fri, Order for Payment Date Request for Inspection Serial Number Date Filed / /-ZZ - /Z, /2 . /e) - 3/ /2— Electrical Contractor /Installer License Number A /o4 0 )V1l — A1/0/4/6 Owner/Occupant / �Q V �/�, County ,7f Jo A ? " � "�`�/ / :P C 1 $G� -7 Job Address Street City ownship This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection. Fee Calculation /Explanation 3s , la- / Ars,Z / e I *2._ 5 a (61 /L. ANC `'1 vet pt'' c7..Tz1 i t Return this Order f with your check payable to the in the amount of $ '5 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 E -mail Address/Website Inspector Signature /dal-