1947 Shawnee RdThis request void
18 months hom
D 18872 7 7/oZ
530 °D
uesA Udtg
-
[! re, Z.
4i Rounh-in Inspection
Required?
?]flendy Now C] Will Npti
fy Inspec-
9-Z3/87 IRYes ?No for When Reatly
LXLicensed Electrical Contractor 1 hereby request inspection of above
? Owner electrical work installed at:
Street Address, Box or Route No. City
!gan
ectron o.
I Township Name or No. Range No. Count
y
Dakota
Occupant IPRINT)
Flax-Pak Phone No.
Power Supplier
N.S.P Address
Electrical Contractor (Company Name)
Hilit arl-ri Tn p,
A Contractor's License No.
Q4Q445
Mailing Address (
l actor or Owner Making Installationl
tnizedg Cont r?Owner Making
DI, Installation) Phone Number
MINNESOTA STATE BOARD OF ELpa,TRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone 1612) 642-0800 ENCLOSED.
7 S7 REQUEST FOR ELECTRICAL INSPECTION E13-00001-06
Il, See instructions for completing this form on back of yellow copy. 7109 7
D -V Below Work Covered by 7his Request
InewlAddl ae0.1 Type of Building I Appliances Wired I Equipment Wired I
I I I I uuplex I I Water Heater I Y I Liohtino Fixtures I
m
Inl t.omeraai [flog, hurnace
I[' o Unloader
InAustr ial Bldg. Air Conditioner SiBullk Milk Tank
N Fee Service Entrance Size h Fee Fo.dm./S.bfad.,s a N Fee Circuits
0 to 200 Am s "
30 Am S 1 3 00 0 to 30 Am s
Above 200 Amps j
100 Amps 3to 1(10 Am s
Swimming Pool e 100Amps Above 100_Amps
Transformers tion Booms Pa rtial•Other Fee
mgns bpeclal inspection $ TOTAL E
C.00
Remarks 3 .50
Rough-in D 1e I, the E tric
Ins pact.,, hereby
certify that the above
14 Final ^tc ?? inspection has been
/T? /J Q P (J ?Y made.
request
� Use BLUE or BLACK Ink
N1> [�-�/s1C,��-�`I�/� ,-----------------,
� For Office Use I
• G��t `� � � � Pertnit#: I� ���� �
�l�y ������ � , � � �_ �
ry I Permit Fee: � �� I
3830 Pilot Knob Road �UN � � LO1� i i
Eagan MN 55122 I �
Phone:(651)675-5675 � i Date Received: �3 �
C3Y:
Fax:(651)675-5694 �
I Staff: �
L------- ---------'
2014 MECHANICAL PERMIT APPLlCATION
❑ Please submit two(2)sets�f plans with all commercial applications.
Date: � t� I Site Address: ��Z�' «`t� ���,1.(L�Cll� �1 UA�� M�
Tenant: Suite#:
j � Cl L �/1�r, 5 ���-S��`�+ ���
, Name: ��:U Q� �I��r l Cl� �I's�C��� Phone:
����#t� y ' i i ' r•
�,�� . `� Address/City/Zip: IZ�IC� I�`�� �}Q- �IrL��1SI�f II,L, YV1� ��33-7 _
������� , Name: ��12-�'�"l:�-1�—���'1��< � License#:����� �JQ l J� �
�� ryd �,� � � � f �, ( ,,1
�"j � �'��� Address ���'"l �.�[`C� �,C�• �• City:��5�(��, �l
� °' C� '�� �car t 2 ��J�- �f���
' F y State: �� Zip: �.J3� Phone:
� � ��F�N
lq���� ` Contact: C� EmaiL• YV1
����y �
New Replacement Additional Aiteration Demolition
��i � ,�� , ,, . '
�\ , t _
'�;���rf�i��C ' Description ofwork� �O�CQ, ) S 1'1 e s `�
y f� ��� %t+�T� �af ti��su�Mte�t-;�r�d�u�td�rr�n�sd„trie�ba��Ga{equip�ea��is,required'�.6�:s�c�er�ed t�y�#�y�t
� .�..'; : ' -��C�.de: f�ea��corrta��f#te�CFiariical 1r�spasc�s�r��tai`�;-.ir�#c�rmat�or�an:pe�?t�ri�ed,��ereen�rt��ne�l�d5.,..=`
RES/DENTIAL COMMERCIAL
� n f= " Fumace New Construction Interior Improvement
r�s — — —
�� Air Conditioner Install Piping Processed
� '��@fi�t���}� — — —
� , •, ': s _Air Exchanger Gas ✓ Exterior HVAC Unit
�����,�� _Heat Pump Under/Above ground Tank �Install/_Remove)
; , �y
�r�.` —
' j���.�... Other
RESIDENT/AL FEES
$60.00 IVlinimum Add or alteration to an existing unit(includes$5.00 State Surcharge)
$100.00 Residential New(includes$5.00 State Surcharge) _$ TOTAL FEE
COMMERCIAL FEES Contract Value$ �� Q - � x.01
$55.00 Permit Fee Minimum r �9
$70.00 Underground tank installation/removal =$ ��"� •v LL_Permit Fee
�If contract value is LESS than$10,010,Surcharge=$5.00 =$ g��� Surcharge"`
""`If contract value is GREATER than$10,010,Surcharge=Contract Vafue x$0.0005
""If the project valuation is over$1 million, please call for Surcharge =$ I ��r 1� TOTAL FEE
I hereby acknowledge that this infortnation is complete and accurate;that the work will be in confortnance with the ordinances and codes of the City of
Eagan;that I understand this is not a permit,but only an application for a permit,and work is not to start without a permit;that the work will be in accordance
with the approved plan in the case of work which requires a review and approval of plans.
��
x ��a n� �J �uC� �
Applicant's Printed Na icant's Signa e
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