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HomeMy WebLinkAboutElectrical Permit 12. 391 For Office Use Only Amount of Check: ter: PennitTRAK Number: (.2 MINNESOTA DEPARTMENT OF 10 37n ' ELE ! 2 3 f / LABOR & INDUSTRY gal. . 4 Request for Electrical Inspection (REI) (permit) P Non- Dwellings and Multi - Family Dwellings Fields marked with an asterisk * are required (as applicable). * TODAY'S DATE Incomplete, inaccurate, or illegible forms may be returned to the submitter. 10/15/2012 * Check One: 12 Contractor or ❑ Registered Employer * Check One Box: ❑ New Bldg or 0 Existing Bldg * Check One Box: ❑ Multi - Family Dwelling or 2 Non - Dwelling (all projects other than dwellings) * Permit Sub -Type (check one box) ❑ Agricultural 2 Commercial ❑ Government ❑ Industrial ❑ Institutional ❑ Recreational ❑ Technology * Project Location (number & street name) * Project County 4805 Dakota St. SE * Project Township: (Please enter only the township name * Project City: * Project Zip or the clay name, not both) Prior Lake 55372 * Owner Name * Owner Phone Owner Cell Owner E -mail Shell (612) 447 -5288 priorlakeshen@gmail.com *Company Type (check one box) © Electrical Contractor ❑ Technology System Contractor ❑ Registered Employer 0 Class B installer *Company License/Registration No. * Name EA005265 Anisia Electrical Services, Inc. * Company Address * City * State * Zip Code 109 Maple Ridge Drive Delano MN 55328 * Company Phone Company Cell *Company E -mail Contact Person and Phone Number (763) 219 -8335 service@anisiaelectric.com Joel 763- 219 -8335 * 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) 0 Ready Now or ❑ Yes or Fi No ❑ Will Schedule Directions to Project Site Hook up power to a new LED price sign Project Site (Contact Person and Phone) Curt 612 - 226 -6005 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 Fee) 40 Requests for Electrical Inspection (REI) with a fee of ;250 or less expire 12 months from the flung 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 material 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. : • I • - REI forms together with the - • • ' - • • - • a • or ; , -74 : • _ • 4218, St. Paul, MN 551 64 -0218 REI 11 (4/11) REI_ 11 _MultiFamilyAndNonDwellings.doc (Revised 4/1/11)