HomeMy WebLinkAboutElectrical Permit 12. 361 i Psi ° ` PERMIT #... W /1- - 36/
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4" CONTRACTOR /REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough -In Inspection Required? Yeses Inspection Other Than Rough -in: It Ready Now
q ) lor j Contractor /Employer Must Schedule All Rough -In Inspections Contractor /Employer Must Schedule All Final Inspections
Will Schedu
Address of inspection - Street Project Description:
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Owner Phone /�
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Contractor /Registered Employer Name Contractor /R istered Employer Mailing Address
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Contractor /Employer Telephone Number Contractor /Employer E -mail Address ElecVcal Utility
Work: .
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Contractor /Employ r Authorized Signature Contractor License Number Job /Project Contact Perso
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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 Mileage Rate of ( )
Recreational Vehicle Site Supply Equipment j 4' SS OA.
( ) Circuits Originating in the Equipment @ $6 Each Other Pl C .2 - i kA V- r.n i .f 70.
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 ( ) @ -Beeh- ( ) New Multi- Family Dwellings @ $70 Each
?0 P GEC ( i.- State Surcharge of $5.00 S
Jew s r 3 / 5 L 153,-.1 3 7 . - Per undd@ $6a C Above the 20 Allowed
Transformers Over 10 kva ( ) $30 Each TOTAL (the fee calculated above or $35 multiplied by the
number of required inspection trips, whichever is greater) / � , j
1 - ''6 ' 1 13 REt— \ t 6- 6 5 Receipt# /, 7 )3 T iIZ. 1
Requests for Electrica Inspection (REI) with a fee of $250 o 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 -In Inspection (s) Date Walt Lusian, Electrical Inspector
952.934.0229
Final Inspection Date
WALT LUSIAN
IAEI Certified
Master Electrical Inspector / r� (0(02----
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
Date Request for Inspection S rial Number Date Filed
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Etectrica( Contractor/Instatter License Number
A" - IVDK I ELEC.,7R.,, Greia0
Owner /Occupant County
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Job Address Street'' ownship
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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 the in the
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amount of $ r r _ by (fourteen days from the date issued)
A service charge of 530 will be added for all dishonored checks.
Inspector Name and Number I For Department Use Only
inspector Telephone Number
Inspector E - ail Addres site
ins or ignature