P - 75640Minnesota Depa�tmen f Labor and Industry
443 Lafayette Road rth
Sti Paul, MN 551 342
Phone: (659 ) 2 064
7TYIMRS: (6 297-4198
wwuv.electricity.state.mn. us
Homeowner
�� Rough-In Inspection Required?
�� Homeovmer Must Schedule All Rc
d ress of Inspecction — Street
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By signing this
REC'D J U L- 6 2007
�G�'� Dl�a-I
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uest for Electrical ins ectibn
� y� Inspedion Other Than Rough-In:
Inspections Homeowner Must Schedule All Final
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�er(s) — Include Area Code(s)
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Ready Norn�
N�iA Schedule
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1 ceriify that I am the ovmer as defjped by Minn. Stat § 326.01 and will legally pertorm the elec�ical vwrk
Owmer Signature � ^�5�. /.X�--/ --
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Fee Calculation
New Home or Assaciated Structure Existing Home/Structure Remodel or Addition
New Home ServicelPower Supply 0— 400 ampere �$35 New Service/Power Su�l� � 0— 400 ampere $35i� � i 1 e��
C/
PJew Homa Senrice/Power Su�TTp y�i07 — 800 ampera �$60
New Home FeederslCircuits
Up to 30 Feeders/Circuits - $100
New Home — More than 30 Feeders/Circ�its (in edd�ion to
Each
Detached Garage or Other Assocfated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other (Specify)
New Serrrft�lPomrer Supply 4B7 = 800 ampef� @$60 -
New FeederslCircuits — Up to 15 FeederslCircuits
(_ �) Feeders/Circuits @$6 Each or 16 to 30 $100
1Vew Feeders/Circuits — More Than 30 Feeders/Circuits
( t�) Feeders/Circ�lts Uo to 200 A(i� $6 Each
_ ( ) Feeders/Circuits @ $2 Each �
Detached Garage or Other Associated Structure
New Servic:�/Power Suppty 0— 400 ampere �$35
New Feeders/Cira�its ( j � $6 Each
Reconneded Feeders/Circuits ( ) @ $2 Each
Other (Specify) Other (Specify) �� �� ` ��
Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 muitiplied
by the number of required inspection trips, , by the numtser of required inspection trips, aD�
whichever is greater) whichever is greater) ��
Requests for Electrical Inspection (REI) with a fee of $25U or less expire 12 morrths from the tilfng date. The owner must have the work completed within the
12 month period or subm(t another 12EI that includes the InspeeUon fee for the uncompleted work. inspectlon fees do not carty over from one REI to another.
A service e e of $30 will be added for all dishonored checks.
I hereby certify fhat I ins�ded the electrical installatlnn herain on the dates stated: For Department Use Only
Rough — In Inspection(s} Date
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This material can b�
TDD (651) 297-4196.
REI 01 (6/07)
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or on a tape. To request, cali
or