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HomeMy WebLinkAboutElectrical Permit 12. 376 I Reset Form I ( Print Form For Office Use Only MINfJESO7A ❑EPAR7MNT OF p� Vi STRAKNumber 1 ELE 37(0 �� L ABOR I NDUSTR Y '" Request for Electrical Inspection (REI) (permit) 443 Lafayette Road North St. Paul, MN 55155-4342 One- and Two - Family Dwellings Phone: (6565 1) 284 -5026 026 www.dli.mn.gov Fields marked with an asterisk * are required (as applicable). * TODAY'S DATE Incomplete, inaccurate, or illegible forms may be returned to the submitter. 10 -04 -2012 * Check One Box: L j Contractor or ❑ Homeowner * Check One Box: ❑ New Bldg or © Existing Bldg * Check One Box: [] One - Family Dwelling (homeowner or contractor) OR ❑ Two - Family Dwelling (contractors only) (It is unlawful for homeowners to perform electrical work on property that is rented, leased or occupied by others) * Project Location (number & street name) * Project County 16047 North wood rd. NW SCOTT * Project Township: (Please enter only the township name * Project City: * Project Zip or the city name, not both) Prior Lake 55372 * Owner Name * Owner Phone Owner Cell Owner E - mail Jim Audit (402) 212 -2813 _ * Company Type (check one box) [1 Electrical Contractor ❑ Technology System Contractor * Company License Number * Company Name AE05997 CA Electric inc * Company Address * City * State * Zip Code 17300 Hibiscus ave Lakeville mn 55044 * Company Phone Company Cell * Company E -mail Contact Person and Phone Number (651) 283 -9509 (651) 283 -9509 caelectricincmn@aol.com Dave 651- 283 -9509 * 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) ❑ Ready Now or p Yes or ❑ No Gi Will Schedule Directions to Project Site Breeze way,baseboards,3 switches 5- recpticals Project Site (Contact Person and Phone Number) Electrical Utility TOTAL INSPECTION FEE from REI fee worksheet, or $35 multiplied Enter Inspection Fee Here» * 70 by the number of required inspection trips, whichever isfreater. A surcharge of $5 is imposed on every permit effective 711/10 Surcharge Fee » $ 5.00 as per M.S. §326B.148, in addition to the inspection fee. * Grand Total (Inspection Fee plus Surcharge Fee) 75 Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing 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 -DU) Voice or TDD (651) 297 -4198. Please submit REI forms together with the applicable fees to: MN Dept Labor & Industry, PO Box 64218, St. Paul, MN 55164 -0218 REI 10 (4/11) REI_10 OneAndTwoFamily.doc (Revised 4/1/11)