P - 75654T+v a.a�arcuo vau IYUIUI
St Paul, MN 155-4342
Phone: (651 84-5064
T1Y/MRS: 1) 297-4198 , • "
www.ele ty.state.mn.us
ContractoNRe istered Em lo er Re uest for Electrical ins ection
Date Rough-In Inspection Ret�uired7 Y� Single Inspection Othe� Then RoUgh-II1;
Ready Now
s� �� ContraatoNEm lo er Must Schedule All Rou h-In Ins ctlons Contractor/Em I er Must Schedule All Final Ins ons
�► Wili Schedule
Address of Inspection — Street City/T ship Coun
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Own Name Project Descripti n
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Owner Telephone Number(s� — Include Area Code(s)
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�Co ractor/Registered Employer N e ContractodRegistered Employer Mailirtg Address
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Contractor/Employer Telephone Number Contrector/Employer E-mail Address Ele�trical Utility
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Con`�mP�oYer Authorized Sign re Contractor License Number Job/Pro ct Con ct Person
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. Fee Calculation
Service/Power Supply 0— 400 ampere @$35 Technology System Davices ( )@� 75¢ Each
ServicelPower Supply 401— 800 empere @$60 Separate Bonding Inspectio� for Swimming Pools and
E ui otential Plan�.s $35 Each
Service/Power Supply Above 800 ampere @$100 Center Pivot Irrigatlon Booms ( )@$35 Each
Plus Electrical Drlve Units $5 Each
FU�v/Ex�Braded FeederslCircuits U� To 200 f►( )�$6 Each - Lo►ninaire Retrofit Modiflcations ( )@ 25¢ Each -- "
Feeders/Circuits Above 20D A ( )@$15 Each Concret�Encased Electrode Inspection ( )@$35 Each
Recc�nnected FeederslCircuits Investigativve Fee $70 Or The Total Inspedipn Fee,
e ( ? @ �2 Eac�
Whichever Is Greater U To $1 000
ManuFactur� Home Park Lot Su Specfal Inspection F� ( ) Hours @$80 Per Hour
PR�Y ( ) @ $35 Each
Pius Miles Th� IRS Mflea e Rate of
R�reatlonal Vehicle Site Supply Equipment Other
Circuits Ori lnatin in the E uf inent $6 Each
Street, Parking Lot, Lightlng Standard ( )@$5 Each Over 600 Volb —�a n,e �wmea ��r�r �,�y a�a r�ir.�c r� m
re�t In aoun�e ane regumr ree (aaea rrot appry eo e�ectric s�gn arid a,utr�e �Igndn9)
Transformers Up to 10 kva ( )@$15 Each � ) New Multi-Family Dwellings @$70 Each
With Up To 20 Feeders/Circuits
Transformers Over 10 kva ( )�$3p �e� ( ) Additlonal Circx�its Above The 20 Allowed Per Unit
Each
Electric Signs ar�d Outline Lightlng TOtal (the fee caiculated above or $35 multiplied
TransformerslPower Su lies $5 Each by the number of requir�i inspection trips, ��,
whichever is greater) �
Raquests for Electrical lnspectlon (REt) with a Tee of �250 or l�s expire 12 mor�ths irom tl�e filing �te. Tt�e co�ractw/employer must have tl�e work
completed within d�e 1Z mornh perlad or subm(t anoU�er REI that includes tlre Inspectlon tee f� U�e uncompleted work, lnsp�on fees do not carry over
irom one 1�1 to a�ther.
A�rvice cha of wfR be added for all dtshonored checks.
I hereby certify that I Inspected the electricel insteltetbn herein on the date.a stated: For Department Use Only
Rough — In Inspection(s) Date •
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Finallnspection �'(� ���� ' �� �J��N o'7 �000
Thls n�er(al ean made arailable in dlfferent torms. such as large priM, Braille or on a tape. To requ�t, aal! 1-8Q0-342-5354 (DIAL-DLI) Voloe or
TDD (851) 29T-d198.