HomeMy WebLinkAboutElectrical Permit 12. 408 4 �-� L iitip�
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n t`. CONTRACTOR /REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough -In Inspection Required? Q Yes Inspection Other Than Rough -in: Q Ready Now
Contractor /Employer Must Schedule All Rough -In Inspections Contractor /Employer Must Schedule All Final Inspections
O(,1 a 1 Q Will Schedule
Add kw f Inspection — Street Project Description:
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Owner Name `\ T C \ ZL. �svY� 0,7)-
Owner Phone
Home: Cell:
Contractor /Registered Employer Name Contractor /Registered Employer Mailing Address
9 . --.. "' S t\-e- s.rt t., i t.1 4v,-,,.r.,,� Ct. ,..rir r s1 So (
Contractor /Employer Telephone Number Contractor /Employer E -mail Address Electrical Utility
Work: Cell:
G It- 2os- %3oy
Contractor /Employer Authorized Signature Contractor License Number Job /Project Contact Person:
IAA, CO ZZS 1 b (t. gas 1 y
FEE CALCULATION
Service /Power Supply 0 -400 ampere @ $35 j. Technology Systems Devices ( ) @ $ .75 Each
V Service /Power Supply 401 — 800 ampere @ $60 Separate Bonding Inspections for Swimming Pools and
Equipotential Planes ( ) @ $35 Each
Service /Power Supply Above 800 ampere @ $100 Center Pivot Irrigation Booms ( ) @ $35 Each
Plus ( ) Electrical Drive Units @ $5 Each
New /Extended Feeders /Circuits Up to 200 A ( ) @$6 Each Luminaire Retrofit Modifications ( ) @ $25 Each
Feeders /Circuits Above 200A ( ) @ $15 Each Concrete - Encased Electrode Inspection ( ) @ $35 Each
Reconnected Feeders /Circuits ( @ $2 Bach Investigative Fee $70 Or The Total Inspection Fee,
_ Whichever is Greater Up to $1,000
Manufactured Home Park Lot Supply ( ) @ $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour
Plus ( ) Miles @ The IRS Mileage Rate of ( )
Recreational Vehicle Site Supply Equipment
( ) Circuits Originating in the Equipment @ $6 Each 1 a Other t•-• W F6-1 /35pe d� 35 —
Street, Parking Lot, Lighting Standard ( ) @ $5 Each � Over 600 Volts — Add the combined service /power supply and
feeder /circuit fee to result in double the regular fee (does not
apply to electric sign and outline lighting)
Transformers Up to 10 kva ( ) @ $15 Each ( ) New Multi- Family Dwellings.@ $70 Each
( ) State Surcharge of $5.00
( ) Additional Circuits Above the 20 Allowed L.5--
Per unit @ $6 Each
Transformers Over 10 kva ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the
number of required inspection trips, whichever is greater) �l `� . JTam/ � " " �} �
PP 35. - 18'I' 4o1(,$) / itj /) Receipt# � "TT ---f
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Requests for Electrical Inspec,iron (REI) with a fee off $250 or less expire 12 months from the filing date. The owner / " p
must have the work completed within the 12 month period or submit another REI that includes the inspection fee for- 676 J/
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. ( (1-14 >
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
tAEI Certified
Master Electrical inspector
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MINNESOTA DEPARTMENT OF
LABOR & INDUSTRY
16275 Sheldon Ave.
Eden Prairie, MN 55344 Office Hours 7:00 -6:30 a.m.
Tel. (952)934 -0229 Mon.-Fri.
Order for Payment
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Date Request for Inspection Serial Number Date Filed
0— /,5" -/2 (z - o eo e 40 -0 - /2
Electrical Contractor /Installer License Number
E E & —riti e-
Owner /Occupant County
FELDRo N 5 0-o
Job Address - Street City nship
I /59e , Cry -OR4Pz <S ' 'R!C L
This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection.
Fee Calculation /Explanation
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Return this Order for Payment with your check payable to thealNIMMIIIMMIIMININNINININUM in the
amount of $ ' 35 + by (fourteen days from the date issued)
A service charge of 530 wilt be added for all dishonored checks.
Inspector Name and Number For Department Use Only
Inspector Telephone Number
Inspector E -mail Ad s/Website
Inspector Sig `-� ----