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HomeMy WebLinkAboutElectrical Permit 12. 387 ''R'.,\,/, oi,--iiii.4. -f 1i7.i t �C I 3 e 7 , ,,„ k e \ '`�` Er°t . CONTRACTOR/REGISTERED EMPLOYER REQUEST FOR ELECTRICAL INSPECTION Date Rough -In Inspection Required? erges Inspection Other Than Rough -in: Q Ready Now / Contractor /Employer Must Schedule All Rough -In Inspections Contractor /Employer Must Schedule All Final Inspectio /i5 - AV :- / ill Schedule Ad r�ss f In tion -Str ee / .: f Project Description: Q ro Owner 7 ©f� .�3 LVf4,4-s L /�'tOG Ci �` U J //I-e A":47 L) ,Q,e 1 7 a. s 1 I erg c�5 lr omen hle' 2G, /- �i'ls Cell: Contractor /Registered Employer Name Contracto /R E ployer Mailing ng � Addr ba le 4,209-6‘ 57e_ ,...4.e. / c_ 26 6, 7 Contractor /Employer Telephone 4umber Contractor/Employer E-mail Address ElectricalUtiliti WWork: / � / Cell: i j / L Ill A ,s - 37/ 2-- • C ntractor /Employer Authorized Si ure Contractor License Number Job /Project Contact Person: 0 0,,,..., do FEE CALCULATION Service /Power Supply 0 -400 ampere @ $35 Technology Systems Devices ( ) @ $ .75 Each Service /Power Supply 401 - 800 ampere @ $60 Separate Bonding Inspections for Swimming Pools and Equipotentia4Planes ( ) @ $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 200A ( ) @$6 Each Luminaire Retrofit Modifications ( ) @ $.25 Each Feeders /Circuits Above 200A ( ) @ $15 Each Concrete- Encased Electrode inspection ( ) @ $35 Each Reconnected Feeders /Circuits ( ) @ $2 Each 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 Other 2 (4 �*- r" t-. J5. r0/ j 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 5 Per unit @ $6 Each - Transformers Over 10 kva ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the , t number of required inspection trips, whichever is greater) !� J 11 0. - C 3c,'(O41 lL ,7�3z Receiut# G 135 Requests for Electriica Inspection (RE!) 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 t 2-4 q (2 3 MI Certified Master Electrical Inspector 11, MINNESOTA DEPARTMENT OF LABOR & INDUSTRY ,ate 1627S Sheldon Aya Eden Prairie, MN 55344 Office Hours 7:048;30 a.m. Tel, (952) 934-0229 MOn.•Fri Order for Payment Date Request for inspection Serial Number Date Filed /0 /7-12-- (2 - /p - Z, Electrical Contractor/Installer Dense Number ✓. /1Gt. F' ' , er,2/ c_.-- 1.94)0 /RP 2.. Owner /Occupant County Job Address - treet City Wnahip / 0.33 45 s Ll ki /.e_. " P RI O R L.A?- This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection. Fee Calculation /Explanation X �U /7'/oN,96 /NS fG 1/a) / � � . ce ( 7n — i our /0- 16-(7) pb o Ali • Return this Order for Payment with your check payable to theaMINIIIIIIIIIIMilliglailiMillik in the ©a amount of $ `J by (fourteen days from the date issued) A service charge of 530 wit be added for all dishonored checks. Inspector Name and Number For Department Use Only Inspector Telephone Number Inspector E -mail Address/We " Inspector Signature (It e„,