Laserfiche WebLink
City ` n ill nes Electrical Permlit Application <br /> IWa uVd otiI� oDn hod — (1(��_754­2983 <br /> IE ata w _ _ rner"e Name � &iner"s�Telelphone Numbers(with area.code) <br /> D B�rsne; <br /> Work:____ <br /> ___________________________— ell I-----I--------——--------------------- <br /> Rough.-In <br /> ___________________iRou h.-Irn inspection Required? Final inspections(Must Be Scheduled) <br /> Yes I❑ No❑ Final inspection; Ready Now❑or fate Ready <br /> If yes the minimum fee is$80 Access(Heeds.Garage Code (Lock Box Code <br /> Horuneowner°Aduust Schedule Afi fti °r-iru frr,s ectiorrs w � or Someone Home❑ ---------------- <br /> - <br /> Ipir¢dek If3eoriituom <br /> Owner Address -- -Iain _______________— C1 <br /> Y—...�-------------------------- ------------ <br /> _______ ______ <br /> _.�. ------------------- <br /> Owner Vgnatuure-by signing this document, U certify Ylhat II am the owner as definers by-MN Statute e do n 326.01 and vdl Vecga0y perform the <br /> eWtriicall work <br /> III uruuill <br /> Please Sign Here <br /> Fax <br /> (Please(Print and Sign oir Type un the Cell Above) Quantity Cost <br /> ---- <br /> ,Please review and co:mplete Sections A and B. 'the fee is the t r of A or B—riot both. <br /> 77 �/%% �G, l//, i /�l,// / 11" <br /> Ir�anele _ <br /> kRe uVa oCd senul sinal.uuith never anal j tlhe sauin e iocatiori_______� __�_ 1100__________________ .______ _________ <br /> I _Bulb painel unritlh neer aneJ In the same locaiiion ______ $4 <br /> __________------_�-- --------- ------------ <br /> place <br /> Prrcfrrr e s arrrueoteei circuits�nraf�. l circuits_are added,extended or _ rkod on add the Fea derd srcuils fee. <br /> Srimianln Dolls _ � <br /> 2 Uns eq ons --- <br /> --------------—M $� pVurs u�irouits ____� <br /> IRemod1. Additions, asgW rIP6in1i the Into„ <br /> 1.2 lnspuectlou! up o'DQ cirouits��-- - ___ ~~______________________ X80______________________ ____---------- _ _________ <br /> �df more than 10 cBrceusfs add decuk fees for ars a bditdourai circuits. —________________________ ___ <br /> ooessor Structures__________ _ � �_ <br /> __________ _— <br /> _____________________ .__________ <br /> IPaneU _ _ _ $5CD plus circuits____________ <br /> 2 mrr �SeVons trench rou?h In and finam 4 <br /> _Cu¢ hae,st fee�ehnreerr�tras o�rtr _ ____________________- <br /> FeedelrlIlrcuGt(Fees __ <br /> _--_._�--� - __ ______ --------------- <br /> New service o s <br /> _ _ --- cpr4Q �P <br /> Additional 100 AMPS $Rrerigt �UP <br /> ..______________ <br /> ___________ <br /> F°eeder / it ii (.- C IPsp __________________ $ er ffeederdcirouuit ____ __ <br /> -if°eederi5i ilii-( D 100 IPs� D td..Per feederfclrcui�_.......� <br /> IFe�nr�e/ irouutsQt T �hQ VWVIF°s�_ _____________ _ _____$15 aper Feeder°oairc�art __. _____________�______ <br /> IR Bderwtilal IVaaruirn IPr Struotau <br /> tip t uuoIpcRiors tripstragi Inr�i umeaitln service of 2QIIps or less(no rrrairruurm for <br /> l 75 maieruurn ___ <br /> service of over 200 AMIPs <br /> Snn le tri fee usuVth iRr mare than clircuaits ____ _ ______________ ___ <br /> IReiinsutua�urw IFs <br /> nspeG"on fee Is in add to allll other fees $qf <br /> �n _.._________.,_.__ _ °fetal)fors Sectiion <br /> 1dn a, % % <br /> IdM of trips Q per trip _ Total'feu°Section IS <br /> Greater of Section A or B(not both) (Electrical inspection(RFI)with a fee of$250.00 or less <br /> State and City Surcharge Fee <br /> --------------------------------- expires 12 months from the filing date.The owner must <br /> Mandatory <br /> -State Cit <br /> d ----m_____ ------------ have the work completed within the 12 month period or <br /> subirnit another IRFII that includes the inspecOon fee for <br /> the uncompleted work.Inspection fees do not carry over <br /> TOTAL IPIEPIrtit T FIEIE SLIIBIMII'TTIEID from one RID to another.A ser0ce charge of$35.00 will <br /> be added for all dishonored checks. <br /> I hereby ceretify that II inspected th electrical installation)herein on the dates Stated:___ _ For Department Use Only_____ ________ <br /> Ftough.4n Inspection(s) fate (Permit <br /> _ Date <br /> ---�-,-.m-m.- - __________________________ _ <br /> Final Inspection date Paid: Receipt M <br /> 22 <br />