P - 75241Minnesota De�itment of Labor and Industry
443 Lafay ��iaad North
St. Paul, M�'�5155-4342
Phone: ( .. ) 284-50�
TTY/MR ; (651) 297-4198
www.ele ' c�hr.state.mn.us
�ate I Rough-In Inspecdon Required?
� • ''� " J ! ' Contrac�or/Employer Must S�E
►ddress of Inspectlon - Street
� �? �� � �� .,�i- ��l �
�n►ner Name
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hroner Telephone Number(s) - Include Area
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:antractor/Registered Employer Name
SUBURBAN ELECTRIC, INC.
:ontrador/Emptoyer Telephone Number
763-498-7215
:ontractodEmployer Authorized Slgnature
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All
Yes
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est for Electrical I
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Ready Now
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14800 28TH AVE N, SUITE 125, PLYMOUTH, MN 55447
:ontractoNEmployer E-rnail Address Electrical U�lity
Job/Project Conta
( �- `�� �;�' �, � i r.;( c��� � CA02503 � T�, .1 ��l % `��1(i .. � �`i t
� Fee Calr.ulation
Service/Power Supply 0- 400 ampere �$35 Technology System Devices
ServicelPowrer Supply 401- 800 ampere (a� $80 Separate 3c�nding Inspectlor
E ul otenUal Planea
( ) @ 75¢ Each
Swimming Pools and
( ) Cu� $35 Each
Service/Power Supply Above 800 ampere @$100 Center Pivot Irrigatlon Booms ( )�$J5 Each
Plus Electrical Deivelln6t�@ $SF�s�i
New/Extended Feeders/Circuits Up To Z00 A{ )�$6 Each Luminaire Retroflt Modiflcadons ( ) Q 25� Each
Feeders/Circuits Above 200 A ( )@$15 Each Concrete-Encased Electrode I�specdan ( )(a� $35 Each
InvesUgati�re Fee $70 Or The
Reconnected Feeders/Circuits ( ) (� $2 Each
Whichever Is Greater U To
Manufactured Home Paric Lot Supply ( )�$35 Each Special InspecUon Fee (
_ Plus ( . 1 MAes C�
of
Street, Parking Lot, UghUng Standard ( )(a� $5 Each Over 600 Volts - aad sne �mea se�om�r s�y ena r�nm�,ac r� m
result in doubte the reguler tee (doea �rot appiy W aterdric elgn erM anllrre IlghWg)
Transformers Up to.10 kve ( )�$15 Each � ) New Multl-Famlly Owellings �$70 Each _
, VVnh Up To 20 Feeders/Circuits
Transformers Over 10 Mra ( )@$30 Each ( ) Addidonal Circuits Above The 20 l�llowed Per Unit
6 Each
Electric Signs and OuUlne Llgh�ng TOte) (the fee_celcul�ted above or $35 mulUplied
Transformers/Power Su iles $5 Each by �e number of required inspection trips, �� ��; �
auhichever is greater)
Requasts far Elechical inspeetlon (REI).with a fes of $2b0 or less expire 12 morrths irom d�a filing date. The oo�rirectorlamptoysr must have the work
comptet� wlthln the 12 month �H�1 or aubmit enother REI �at Mcludes the b�spectlon fee for the uncompieted work. I�pectlan feea do not carry over
from orte REI ta a�rother:
A aerofee ch e of S30 wlq be added for ep diahom�red checka.
I here6y certify that I tnspected the electrlc�l InstellaHon herein on the datea stated: For Departme�rt Use Only
Rough - In InspecUon(s) Date (�,.,\� _s �' i r�-�
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TDD (8S1) 297-4198.
REI 03 (6/07)
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