HomeMy WebLinkAboutElectrical Permit 12. 0059 F YRi
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° "�� `� HOMEOWNER REQUEST FOR ELECTRICAL INSPECTION
Inspection ns ection Other Than Rough -in: 0 Ready Now
Date Rough -In Inspection Required? 0 p
0 t" /i -L Homeowner Must Schedule All Rough -In Inspections Homeowner Must Schedule All Final Inspections Will Schedule
Adss of Inspection Street \ r Project Description:
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Owner Phone
Home: Cell: (4 ^ (ez(c) - 31389
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Owner Mailing Address (if different from above) Electrical Utility
By signing this do en „[ certify that I am the owner as defined by Minn. Stat.32 5.01 and will legally perform the electrical work.
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Owner S not e •
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FEE CALCULATION
New Home or Associated Structure Existing Home /Structure Remodel or Addition
New Home Service /Power Supply 0 -400 ampere @ $35 New Home Service /Power Supply 0 -400 ampere @$35
New Home Service 401- 800 ampere @ $60 New Service /Power Supply 401 -800 ampere @ $60
New Home Feeders /Circuits New /Extended Feeders /Circuits Up to 15 Feeders /Circuits ( )
Up to 30 Feeders /circuits $100 Feeders /Circuits @ $6 Each or 16 to 30 '
New Home - More than 30 Feeders /Circuits (in addition to above New/ ES tend Fee/Circuits d Feeders/Circuits More
oo than 30
@ $6 Each
( ) Feeders /Circuits up to 200A @ $6 Each () t
Other (Specify) Reconnected Feeders /Circuits ( ) @ $2 Each
Manufactured Home Park Lot Supply ( ) $35 Each Special Inspection Fee ( ) Hours @ $80 Per Hour
Plus ( ) Miles @ The IRS Mileage Rate of ( )
Detached Garage or Other Associated Structure Detached Garage or Other Associated Structure
New Home Service /Power Supply 0 -400 ampere @$35 New Home Service /Power Supply 0 -400 ampere @ $35
New Feeders /Circuits ( ) @ $6 Each New /Extended Feeders /Circuits ( ) @ $6 Each
Other (Specify) Reconnected Feeders /Circuits ( ) @ $2 Each
Other (Specify) State Surcharge = $5.00 tj --
TOTAL (the fee calculated above or $35 multiplied by the TOTAL (the fee calculated above or $35 multiplied by the
number of required inspection trips, whichever is greater) number of required inspection trips, whichever is greater)
1 Receipt # ( ±.c) 0
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 -In Inspection (s) Date Walt Lusian, Electrical Inspector
952.934.0229
Final Inspection Date