HomeMy WebLinkAboutElectrical Permit 12. 239 %e PT - & 6369(.0
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4f'' °s'* CONTRACTOR /REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough -In Inspection Required? 0 Yes Inspection Other Than Rough -in: 0 Ready Now
, Contractor /Employer Must Schedule All Rough -In Inspections Contractor /Employer Must Schedule All Final Inspections
Will Schedule
Address of Inspection - Street Project Description:
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Owner Name r E::; . �e.v
Owner Phone imp
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Home: Cell:
Contractor /Registered Employer Nam Contractor /Registered Employer Mailing Address
.mac 3Ir ruer (✓1r1 5631
Contractor /Employer Telephone Number Contractor /Employer E -mail Address // Electrical Utility
Work: Cell: I! rtu
Contra or /Employer Authorized Signature Contractor License Number Job /Project Contact Person:
4 SAO 0O/5 -/?
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 809 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
( ) Circuits Originating in the Equipment @ $6 Each Other q
Street, Parking Lot, Lighting Standard ( ) @ $5 Each Over 600 Volts - Add the combined service /power supply and Cly
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 -
number of required inspection trips, whichever is greater) '
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The ownerz
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. &Lei
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I hereby certify that I inspected the electrical installation herein on the 1 /4/0
dates stated: 6 .
Rough - Inspection (s) Date Walt Lusian, Electrical Insp >t C) u
952.934.0229
-
Final Inspection Date
WALT LUSIAN
IAEt Certified
Master Electrical Inspector
' MINNESOTA DEPARTMENT OF
L ABOR & 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 Serial Number Date Filed
/o - 2. /2- / 2 — 62'3 ? 7 - /o --/2.
Electrical Contractor /Installe License Number
Owner /Occupant /�` - County /�
s/( ..0T .84 s c_._o 77
Job Address - Street City wnship
/ 737 SELF A 191/1-- P /fl L
This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection.
Fee Calculation /Explanation
0 . 0 C 2 4 / 4 1 2 s ' c .E, - oily
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Tor4i_ �£.- 23/.°4
R/t-rod//f ' /1/z7 /,3 .
Return this Order with your check payable to the in the
amount of $ 704 by (fourteen days from the date issued)
A service charge of $30 will be added for all dishonored checks.
Inspector Name and Number For Department Use Only
Inspector Telephone Number
Inspector E -mail AddresssMiebsite
Inspector Signature/ / i '`" " {._ .—.-� ✓