HomeMy WebLinkAboutElectrical Permit 12. 260 OF ' PRIp?
PERMIT # 12 -
CONTRACTOR/ REGISTERED EMPLOYER REQUEST FOR
ELECTRICAL INSPECTION
Date Rough- In Inspection Required ? Yes Inspection Other Than Rough-in : III Ready Now
Contractor/Employer Must Schedule All Rough-In Insp ctions Contractor/Employer Must Schedule All Final Inspections
® Will Schedule
Address of Inspection — Street Project Description :
3 (4:�l ; l61S aAl. eu .
Own r Na e
Owner Phone l /
Home : Cell : 61 Z. T J' Z.
Contractor/Registered Employer Name Contractor/Registered Employer Mailing Address
1
Ste . )E lPd� Co � �� �a z>N OZ S-;� 3 fro t -sf-
Contractor/Employer Telephone Nun&& Contractor/Employer E- mail Address Electrical Utility
Work: Cell :
s67-3S7 � 2Y -/9 ? `/ ZJdjsc �2u . , � �" P,r,e� � �, .ve + 662 C
Contractor/Employer Authorized Signature Contractor License Number Job/Project Contact Person :
FEE CALCULATION
Service/ Power Supply 0400 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
1pt Plus Electrical Drive Units @ $5 Each
New/Extended Feeders/Circuits Up to 200 A ( ,1 @$ 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
Recreational Vehicle Site Supply Equipment Plus Miles @ The IRS Mileage Rate of
( ) Circuits Originating in the Equipment @ $6 Each Other
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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)
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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 u;
number of required inspection trips, whichever is reater) f 7 U
L `��p'j6Vk Receipt # J
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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
WALT LUSIAN
IAEI Certified
Master Electrical Inspector
MINNESOTA DEPARTMENT OF
LABOR INDUSTRY
i4ML
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
Electrical Contractor/Installer License Number
Q5�7EFr ���
Owner/Occupant County
CO2 1t'11V C045>701(2L (*fr1an2 ( s
Job Address - Street ownship
�S �21) 51
This Order for Payment is for additional fees associated with the above referenced Request for Electrical Inspection .
Fee Calculation/Explanation
Ur 10 6;0o C1R(f 1;rS l 0 Q .
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Return this Order for Payment with your check payable to thee IN in the
amount of $ 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 II Addre ebsite
Inspector Signature