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HomeMy WebLinkAboutElectrical Permit 12. 381 It. ems PERMIT # 12-- 3 c) .1. 1 "5 ? CONTRACTOR /REGISTERED EMPLOYER REQUEST FOR ELECTRICAL INSPECTION Date Rough -In Inspection Required? 0 Yes Inspection Other Than Rough -in: Ea Ready Now )O/ a J l \ Contractor /Employer Must Schedule All Rough -In Inspections Contractor /Employer Must Schedule All Final Inspections 0 Will Schedule ddress of Inspecti Street Project Description: a C� Ow� �� � f_7h f D f -1 J c� �vse 2���ne� 4 1o0(.,�.,P , m � e & ( i c_ rce i Owner Phone /� qq Home: 5 i9 S _r� t Q `-J5Q cell: Lrn l t - ire. m 0 �e,\ ontractor /Registered Employer Name Contractor /Registered Employer Mailing Address Pn t;� J ae . C� i $90 Venn Oct Ave-- e � 1e 1 A l1 B Contractor /Employer Telephone Number Contractor /Employer E -mail Address Electrical Utility �� m 4 sc y q,- L i 3,a S O3 r § , _\G.ne Vs Kern c.,(ti cJ- Q.. cXoi n Contractor /Employer Authorized Signature Contractor License Number Job /Project Contact Person: J - S A 00 ) 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 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 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 Mileag Ra e of ( ) Recreational Vehicle Site Supply Equipment A` � ( ) Circuits Originating in the Equipment @ $6 Each Other la4 ' t p f 4,,,_ r j- 41 aJ 1.0 D Street, Parking Lot, Lighting Standard ( ) @ $5 Each Over 600 Volts - Add the combined serow 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 Per unit @ $6 Each Transformers Over 10 kva ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the ,f.�,, number of required inspection trips, whichever is greater) �(�J Receipt # e 73 (p 12.2.. 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 1451 Certified Master Electrical inspector MINNESOTA DEPARTMENT OF I LABOR & INDUSTRY 16275 Sheldon Ave. 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 Sen Number Dat Fild /" - J3 /2 - 028/ ' e /o - z. -/ Electrical Contractor/Installer License Number k N➢ ttJ vrRi e CA © 0 Z 7 9 Owner /Occupant County L9 /E)ie 1c/7 Job Address - Street _ a y & - t _ /Cto This Order for Payment is for additional fees associated with the above referenced Request for Electrical inspection. C Fee Calculation/Explanation cS Vic£ , , . 00 7 NsCr/ 04unAtat, Ckis 2 pat 20 iQ£CnNNF.GT£-b C�crs Doc - O �� TOTlL F(.-E. 1 f 7. as /11 01 )33 7a, pa +3>9- LANcc. Du.-- A z747. 0' Return this Order for Payment with your check payable to the in the amount of $ 7 eel by (fourteen days from the date issued) A service charge of S30 will be added for all dishonored checks. inspector Name and Number For Department Use Only Inspector Telephone Number Inspector E-ynait Address edit Inspector Signature ti `2