P - 75530Minnesota Departrn of Labor and Industry RESIDENTIAL ELECTRIC�L �I�IT BY CONTRA.CTOR
443 Lafayette Roa orth PERMIT # � �� `� � � �
St Paul, MN 55 342
Phone: (651) ' 5064 REC
TfY/MRS: ( 297-4198
v�uv.elecbi .state.mn.us
Con ctor Re uest for Electrical Ins ection — One Fami! Dwel[in /Associated Struciure
Date Rough-In Inspedion Required7 Yes Single Inspedion Ofher Than Rough-In: � Ready Now
Confractor Must Schedule Ali Rou h-In Ins ecfions Contractor Must Schedule All Final Ins ctions ❑ Will Schedule
Address of Inspedion - Street C' lTowmship County
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Owner tJame Projed Desr,ripti n
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OwmerTelephone Number(s - Inclu Area Code(s) �� 5 v� 0���
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Coritractor Name Contrador Maiting Address
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Con ctor Telephon Number Contractor E-mail Address Elec�rical Utifity
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Con or Author¢ed Signature Con ctor Licen N ber • Job/Project Coritact Person
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. Fee Galculation
New Hame or Associated Structure Existing Home/Strucivr� Remodel or Additlon
. Plew Dwelling Service/Power Suppy U- 40U ampere �$35 Nevv Service/Povuer Suppiy 0- 400 ampere �$35 � C�'
New Dwelling ServiceJPower Suppy 401 - 8D0 ampere @$60 i�ew ServicelPower Supply 401- 800 ampere �$60
Nevo Dwrelling FeederslGircuits New F ers/Circuits - Up to 15 Feeders/Circaiits �" —�
U to 30 FeedersJCira�its -$100 Feeders/C'ira�its $fi Each or 16 to 30 $100 °�
New Home - More than 30 �eeders/Cira�its (in addition to New Feeders/Circuits - RAore Than 30 Feeders/Circuits
above FeederslCircuits U To 200 A $6 Each Feeders/Circuits U to 200 A $6 Each
Other (Spec�fy) Reconneded Feeders/Circui�s
Feeders✓Circuits $2 Each
Detached Garage or Ot6er Associated Structure Detached Garage or Other Associated Structure
New Service/Power Supply 0- 400 ampere �$3b New Service/Power Supply 0- 400 ampere �$35
New Feeders/Circuits ( ) � $6 Each Neuv Feeders/Circuits ( ) � $6 Each
Other (Specify) Reconnested Feeders/Circuits ( ) @ $2 Eadi
Other (SPeaiY) Other (SPecifY)
TOtal (the fee calculated above or $35 multiplied TOfi.al (the fee �Iculated above or $35 multiplied
by the number of required inspedion trips, by the number of required inspedion trips, '�]^
whichever is greater) � whichever is greater) / L�
Requests for Electrieal Inspectlon (REI) wfth a%e of $250 or less expire 1 Z months ftom the fliing date. The corrtractor m�t have the work completed withir�
the 1 Z month peNod or submft another REI that fncludes the ins�on fee for the uncompleted work Inspectlon fees do not carry ovet from one REI to°
another.
A service eharge of $30 wfll be add for all dishonored checks.
' I hereby certlfy that I inspected the electrir,�l installatlon herefn on the dates stat�i• For Departrnent Use Only � jl•
Rough - In Inspedion� � S � . �J
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TDD (651j 29T-4198.
REI 02 (6l07)
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large print, Breflle or on a tape. To request, call
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