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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? .�,..nQ� V� ���3�iC4uvn — f� / - fo �" i Owner Name � ���tt� � STANDARD �� . � �.�� l�. �pection - One Famii � Yes Single Inapedi� 2e� �f�`n �,�vt � - ��cluae Area code�g, ���� CTRIC CO., INC. a Number _ ���-K..` ��� Dwelling/Associa ?ther Than Rough-In: �edute All Final Ins ecdon Coun�� Structure Ready Now Y Will Schedul� �f�. ��. ���� f 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 � � °� �� �� � r �� Final Inapection Date �� Jt C� �� ���� L� `�_.� �✓ �- ° t� 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)