P - 75540. . ' . ', p�+'`.
Minnesrota Deparime' �of Labor and lndustry
443 Lafayette Ro� fNorth
St Paul, MIV 55�5-4342
Phone: (651).�4-5064
RJiRS: , 1 } 297-4186
v.ele ' .state.mn.us
o ctor Re uest for Electrical lns ectio
- � Rough-In Inspection Required? ❑ Yes
� " D Contrador Must Sd�edu{e All Rou h-In Ins ectioi
d ed
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O►�er�e�hone Nu� — Include� �
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C ckor Name
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Contrador Telep o e Plumber
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RESIDENTIAL ELECTRICAL PERMIT BY CONTRACTOR
PERMIT #
RECENED:
— One Famil Dweliin /Associated Strucfure
Single Inspectian Other Than Rough-In: � Ready Noyd
Contractor Must Schedule All Finai Ins ctions WiA Scf�iule
_ CityiTownship County�
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Projed Descxiption
Gc� l�-� ���JV C ��o�r�� �
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'z ? �06`� �t� �- ,� � �s � �.�
�r E-mail Addr�ss Electric�l Utit'
,� �/� � Y�� � , � �-� ��� � .
�r Li�nse Number • Job/Project ContaCt Person
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Fee Caiculation
New Home or Associated Structure Existing Home/Strucivre Remodel or Addition
New Dweliing Senrir�/Power Suppiy 0— 400 ampere �$35 New Senrice/Powrer Supply 0— 400 ampere �$35
New Dwel{ing Senri�/Power 5upply 401 — 800 ampare �$60 New Service/Power 5upply 401 — 8D0 ampere �$60
IJaw Rwalline Fr±�rlere%[:irru� NPw F�iarc/C_iwitc — l le fn 15 FPar�arelf _imihe -
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to 30 Feeders/Circuits - $100
Feeders/Circuits U� To 200 A[a� $6 Each
ira�its — Wfore Than 30 Feeders/Circuits
FeederslCircUits U� to 200 A lo� Sfi Eac
Detached Garage or Ot6er Associated Siructure Detached Garage or Gther Associaied Structure
New 5ervice/Power Suppy 0— 400 ampere �$3b New ServiceJPower Supply D— 4UD ampere @$35
@lawfeed�4s/Circuits ( 2 ) � $6 Each lZ New FeedersJCircuits ( ) @ $6 Each
Other (Specify) Reconnested Feeders/Circuits ( ) � $2 Each
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Total (ihe fee calwlated above or $35 multiptied Total (the fee calculated above or $35 multipfied
by the number of required inspedion irips, by the number of required inspedton trips, �C��
vrhichever is greater) whid�ever is greater) �
R uests for Electrical lns ction wfth a iee of $250 or less 6�
eq pe (REI) expire 12 morrths from the BBng date. The cor►tractor must have the work completed wlthin �
the 12 month period or submR arrother REI that includes the Ins�on fee for the uneompleted work. Inspecdon fees do not ca ovet from one REI to
another.
A servlee eharge of $30 witl tra added tor all dishonored eh�ks. :��•
t hereby certiy that I inspeded fhs eleaficai fistailafian herein on the dates stated: For ep n se Only
Rough — In Inspedion(s)
available in different fomis,
TDD (651) 29T-0�19B.
REI 02 (6/07)
Date
uate //
/1 �/
as large prii
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REC'D AUG 0 7 2008
or on a tape. To request, call 1-800-342•
or