P - 75484Miirmesrota Departrnenf of Labor and Industry
443 Lafayette Road North
St Paul, MN �155-4342
Phone: (651� :�84-5064
TfY/MRS: ��61) 297-4198
v�v�w.ele�cityr.state.mn. us
Con�actor Re uest for Electrical
� Rough-In Inspection Required?
� jD� Contractcr Must Schedule All Rou
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Owner Telephone Number�s) — fnciude Area Cade(s;
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Ccntrac�tor Name �►�
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Contractor E-mail Address Electri�l Ufility
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RESIDENTIAL ELECTRICAL PERMIT BY CONTRA.CTOR
PERMIT #
RECENED:
tion — One Famil Dwellin /Associated Structure
y� Single Ins�di�n Other Than Rough-In: Ready Now
:c�ions Contrador Must Schedule All Final Ins 'ons Will Scl�edule
Citylfowmship County
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Proj�d Des 'pbon
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Fee Calcutation
hlew Home or Associated Structure Existing Home/Structure Remodel or Addiilon
New Dweliing Service/Power Suppiy 0— 400 ampere �$35 New 5ervic�lPovver 5upply 0— 400 ampere �$35
New Dwelfing Service/Power Supply 401 — BQD ampere @$60 Pfew Servi�/Power Supply 4U1 — 8D0 ampere �$60
New Dwelling Feeders/C'rca�its New Feeders�Circuits — Up to 15 Feeders/Cir�its �
U to 30 FeedersJCira�its -$100 FeederslCirc,�its $S Each or 16 to 30 $100
New Home — More than 30 �eeders/Ciraiifts (in add'dion to New Feeders/Circ�uits — More Than 30 Feeders/CircUits
��,,..vi i ��oorlprctCirr��ffc I ln Tn 900 A� S6 Each ( ) FeederslCircuits U� to 200 A(a� $6 Each
Other (Specify) rceconneczea reeoersrwrcuRS �
Feeders/Circ�its $2 Each
Detached Garage or Other Associated Structure Detached Garage or Other Associaied Structure
New Senrice/Power Supply 0— 400 ampere �$35 New Service/Power Supply 0— 40D ampere @$35
New Feeder�CircUits ( ) � $6 EacJi New Feeders/C'�its ( ) @ $6 Each
Other (Speciiy)
Reconnesaed Feeders/Circuits ( ) @ $2 Each
Other (SPecifY) Other (SPeafY)
Total (the fee calculated above or $35 multiplied Total (the fee catculated abova or $35 multiplied �
by the number of required inspectlon trips, by the number of required inspedion fips, � D
whichever is greater) whichever is greater)
Requeste for ElecLical lnspettion (REI) wffh a iee of $250 or less exphe 12 months from the ftHn date. The cordractor must have the work completed wffhin
ffie 12 month �riod or submk arrother REI that includes the InspecUon fee for the uncompl woric. Irr�pecHon fees do not carry over from one REI to
another.
A servlee charge of $30 will be added for all honored checks.
I hereby certify that I inspeded fhe electrical inslallatfon herefn on fhe dates staterl: For Department Use Only
Rough — In Inspection(s) _ Date
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Final Inspeatian
This material can
TDD (659) 297-0�198.
REI 02 (6/07)
ava(lable
Date
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as large prl
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or on a tape. To request, call 1-800-342-535�
or