P - 75390, 443 Lafe
St. Paul,
Phone:
7
of Labor and Industry
297-4198
�te.mn.us
r Re uest for Electrical In
Rough-In Inspectlon Required?
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Owner Name �
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STANDARD
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�pection - One Famii
� Yes Single Inapedi�
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- ��cluae Area code�g,
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CTRIC CO., INC.
a Number
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Dwelling/Associa
?ther Than Rough-In:
�edute All Final Ins ecdon
Coun��
Structure
Ready Now
Y Will Schedul�
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2672 MAPLEWOOD DR. - MAPLEWOOD, MN 55109
� �jJ�slB'%���i�� I CA01715 I ��q, � ���
Fee Calculation ��`-�� - 7�,`3 �
New Home or Assoclated 5tructure Existing Home/Structure Remodel or Addltlon
New Dwelling Service/Power Supply 0- 400 ampare (� $35 New Service/Power 5upply 0- 400 ampere (� $35
New Dwelling Service/Power Supply 401- 800 ampere (83 $60 New Service/Power Supply 401- 800 ampere (d� $60
New Dwelling FeederslCircuits Naw/Extended FeederslCircutta _ � i� f„ ���ooae.���,,,,,,,;.�,
U to 30 Feeders%Circ:uits - $100 � � .�
- More than 30 Feeders/Cfrcuits (in eddition to New/Ex
C�'i,'177
Detached Qarage or Other Associated Structure
New Service/Power Supply 0- 400 ampere (c� $35
New Feeders/Circults ( ) � $6 Each
- More
Detached Qarege or Other Associated Structure
New Service/Power Supply 0- 400 ampere aCi $35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected FeederslCircuRs ( ) @ $2 Each
TOtal (the fe� calculated above or $35 multiplied Totel (the tee calculated ebove or $35 multiplied -�
_ by the number of requirad fnspection Mps, by thc� numbe� af requE�ed In��a;tiQn trips, � �� �
whichever is greater) whichever is greater)
Requests for ElecUicallnspecUon (REI) wlth a fee of 5260 or tesa expire 12 months irom the flling dete. The contractor must have the work completed w(thin
the 12 mo�rth peNod or submft enother REI th� Includes the inapectlon fee for the um�mpleted work, Ir�pectlon f�a do not carry over i►om one REI to
enother.
A servlce charge of SSO wlll be added tor ell dlshonared checks,
I hereby certlty that I insp�cter! the e�ectric�l InstallaUon herein on the dates steted; For Depertrnent Use Only
Rough - In Inspection(s) Date � � °�
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Final Inapection Date �� Jt C� �� ����
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Thls meteriel cen be made avallable In dlfferant fortns, such as lerge print, Brallle or on a tepe. To requesf, call 1-600�42-63W (DIAL-DU) Volce or
TDD (669) 297�188.
REI 02 (6/07)