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Minnesota Dapailment of Labor and Industry
443 Lefayetfe Road North
St. Paul, M ; 5�1°55-4342
Phone: ( 1 j 2845064
TTYlMR (651) 297-4'#98
www.el ricity.state.mn.us
ContractorlRe istered Em !
13ate Rough-In inspection Requfred? [
1 y''f'- ConVactodEm lo er Must Schedule AU Rou -In In:
Address of Inspeetion - Street
_ 2�00 — 5'1�' A�veh,t.ce. �
Owner Name � -'
_ 1-�i�4�a �`! 18
Owner 7elephone Nu�i erjs) - Include Area Cotle(s)
Q5a • $��SS - Sc�r C�taou,co�,
Corrtractor/Registered Employer Name Contrac eai
PARSO�lS ELECTRIC
rer Re uest for Electricaf In
ye8 Sfngle InspecUon Other Than Rough-In
�tions Contractor/Emalover Must Schedule Af
P
Car tua�ln � i oad
r-35�35
5960 MAiN STREET NE, MINNEAPOLIS, MN 55432
{763) 571 000 service-electrical@parsonscorp.com
Contracto loyer {hari d ignature Contractar License Number Job/Proj
CA03573 �
Fee Calculation
Serviae/Power Supply 0- 400 ampere Q$3S Technology System Davfces (
ServfceiPower Supply 409 - S00 ampere �$60 Separate Sonding Inspectlons for ;
E uf tentlal Pfanes
- - - -- -- — - - - ro.,�o��+,.,;.,�Er�., o..,...,�, i
Service/Power Supply Afwve 800 ampere Ldi $100
New/Exiended Feeders/Circuits Up To 200 A(/�) @$6 Each
�.:J
Feeders/Circuits Above 200 A ( )@$15 Each
Reconnected Feeders/Ctraaits ( ) @ $2 Each
Manufactured Home Park l.ot Supply ( )�$35 Each
Plus ) Electrical Drive
� Luminaire Retroflt Modi�ications ( T
Concrete-Encased Electrode Inspection (
InvestlgaUve Fee $70 Or The Total Inspe�
Wh(chever Is Greater Un 7o S1.ono
) @ 75¢ Each
) GaD 25¢ Each
) Q $35 Each
Plus ( ) Mtles � The IRS MAeage Rate of
Other
Ready Now
bVip Schedule
Circu�its In the ment $�€ach -- I
Streef, Parking Lot, Lightlng Standard ( )@$5 Each �ver 600 Volts -- aaa are w,onm� �,��r a�ty �a re�asnonoue r�e ro
ras�91 N doutte tha repulet tee (does �rol eppiy to elerdria slgn eml autlfne FgM6tg)
Transformers Up to 10 kwa ( }@$15 Each � ) New Multl-Famfiy Dwellings �$70 Each
IMth Up To 20 Feeders/Circuits
Transformers Oerer 10 kva ( )@$30 Each ( ) Additlonat Circuits Above The 20 AUowed Per Unit
Each
Electric Stgns and OuGine Lighting Tota! {the fee calculated above or $35 multlpUed
TransformarslPawer Su Iles $5 Each by lhe number of required inspecffon frips, �i
whichever fs greaterj �-!'g, '"
Requests far Electrtcal fispection {RHI} with a fee of 5260 or less expire 12 months from the Flling date. The contractor/employer musf hava the work
completed with(n tho 12 month period or eubmit another REI that tncludes fhe inspection fee for the uncompfeted work. InspecUon fees do not carry over
hom one REI to another.
A service char a of $30 will be added for all dishonored chacks.
I hereby certify that I inspected tha electricat instaliarion herein on the dat� steted: or De nt Use Onty
Rough - In Inspeabon(s) Dafe � (� � ���� �
Thls material can be
TDD {651) 297-A188.
REI 03 (6/Q7)
Dat �� IV � V�, 0 2000
� �. r C'J
torma, such s large print, raill� ar on a tape. To request, call 1-300-34
or