HomeMy WebLinkAboutElectrical Permit 12. 375 -
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M���Esoj° CONTRACTOR/ REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough- In Inspection Required ? 0Yes Inspection Other Than Rough-in : Q Ready Now
Contractor/Employer Must Schedule All Rough-In Inspections Contractor/Employer Must Schedule All Final Inspections
Will Schedule
Ad re of Inspection — Street Project Description :
C L 1 vrO /V ��uJ S r vG� 1=/Alvl / L f' /4c�� —
7 0 per Name
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Owner Phone
Home : Cell :
Contractor/Registered Employer Name Contractor/Registered Employer Mailing Address
Contractor/Employer Telephone Number S r2 — Contractor/Employer E-mail Address Electrical Utility
Work: � y7_ L /% Cell : yoE - 21a7D Ji ,� fez / ecl C' r A
Contra ctor/Em ployer Authorized Signature Contractor License Number Job/Project Contact Person : 4> � 2 —
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
E ui otential 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/Ciryui s Up to 200 A ( , �;6$6 Each ��l / 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 Milea a Rate of
Recreational Vehicle Site Supply Equipment /� / � ! �/r/� j� d f 3 5 d
( ) Circuits Originating in the Equipment @ $ 6 Each Other / V I Z r ` Nl l/
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 0
State Surcharge of
( ) Additional Circuits Above the 20 Allowed
Per unit @ $6 Each
Transformers Over 10 kv ( ) @ $30 Each TOTAL (the fee calculated above or $35 multiplied by the 0.^
number of required inspection trips, whichever is greaterl
�L� 19 �0 er.l 3 z5 (d��� 46 4 416 Receipt #
Requests for ectrical 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 - In Inspection (s) Date Walt Lusian, Electrical Inspector
952 . 934. 0229
Final Inspection Date
WALT LUSIAN
1.4E1 Certified
Master Electrical inspector
MINNESOTA DEPARTMENT OF
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 Serial Number Date Re
Electrical Contractor/installer License Number
Owner/Occupant County
Job Addfess - Street Ci ownship
This Order for Payment is for additional flees associated with the above referenced Request for Electrical Inspection.
Fee Calculation/Explanation
200 .
/ 0 Q .
�i�iv �INT P 11� l31S'. a �4
7�v i
Return this Order for Payment with your check payable to the ommmmmmmmiow in the
amount of $ o by (fourteen days from the date issued) If
A service charge of S30 will be added for all dishonored checks.
Inspector Name and Number For Department use Only
Inspector Telephone Number
lnspe for -m 'I Addres ebsite
Inspector Signature