P - 75510iJiinnesota Departrnent of Labor and lndustry RESIDENTIALEL.ECTRICAL PERMIT BY HOMEOWNER
443 Laiayette oad North PERMIT # G7` �"FU U �� `(�
Sti Paul, MN: 5155-4342 G� �
Ph�ne: (6 284-5064 RECEIVED: / - %O — Cs
TlY/AARS' 651) 297�196 ,
wwvw.e city.state.mn.us =
Homeowner Re ue or Electrical Ins ectib�n
Date Rough-tn lnspection Required? es Inspeefic,n OfherThan Rough-In: � Re Wov�
��� 0` vc� Homeoramer Must Schedule All Rou h-ih Ins 'ons Homeavrner Must Sc�edule All Fnal ins ctions I! Schedule
Address of Inspection - Street �„ City/Township Ccu ty
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Owner Name Projed Q�scription
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OwnerTeleph�ne Number( Indude Area Code(s) �y �� �� N�� � •
� �43 ` S�� � �°-r� �"�`
Owmer Ma�Ting Address - 5treef City State Trp C�de
Owmer E�-m�ail�Ad� dr�ss Ele 'cal tJt�7�ty .
1 3(� 1N�S D�J � C C�Y1r� _
By signirtg this dor.ument, I r.�riify ft�at 1 am ihe owner as defined by Minn. 5tat § 326.D1 and anU legally perForm t'F►e electric.al work
Owner Signature .
Fee Calculation
New Home or Associated Structure Existing Home/Structure F�emodel or AddifiJan
New Home Setvic�/Power 5uppfy 0- 400 ampere @$35 New Servia:IPovv�r Sup ��� 0- 400 ampere $35 . ��
Newiivm� ServieaP?-�aeF �uppy 401 - 8�0 ar�efe @ $68 - _ r-�Pfy -- - 401- SDB ampere � S6D � - - -
New Horsie FeederstCircuits N F ets/Circurts - Up to 15 Feeders/C'vcuits �;
U to 30 FeederslCircuffs -$100 FeedersJCinxr�s $6 Each or 16 to 30 $10D
New Home - More than 30 Feeders/Circuits ('in addi�on to iJew eedersJCircufts - More Than 30 Feeders/Circvits
above FeedersJCircuits U To 200 A $6 Each Feeder�/Cht�its U to 20D A $6 Each o
Other (5pe�ify) Reconnected FeederslCircuits � � �
. FeederslCircuits $2 Each
Detached Garege or Other Associated Structure Detached Garage or Other Associated Structure
New ServicelPower Supply 0- 400 ampere @$35 New 5ervice/Power Supply 0- 4Q0 ampere �$35
New FeedersJC'tr�uits ( ) @ $6 Each New Feeders/Circa�its ( ) @ $6 Eadi �
Other (Specify) Re�nnected FeederslCircu'�ts ( j@$2 Each
Other (SpecifY) � Other (SPg�Y) � .
Total (the fee ca{cvlated above or $35 mul6plied Total (fhe fee �Iculated above or $35 multiplied �
by the number of required inspedion trips, , by the number of required inspection trips, ,��
whichever is greater) whiahever is greater)
Requests for Eleettical Inspection (REI) wfth a fee of $250 or less exp[re 12 motrths from the filing date. The owner must have the work completed w e;
12 morrth period or submit another REI fhat includes the i�pection fee for the uncompleted wo nsped3on fees do not carry �ver from one REL ano
A service e of $3D wfll ba added for aq nored checks.
I hereby cert3fy t I ins the el�trical installatiun t�refi on tlie dates stated: For D��„1 � sl �ly��
Rough - In pe 'o s) ' Date
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Final 1 p' n �a� �� v����+ o�OOS �
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This te�ial can be made avai(able in different forms, sueh as large print, Braille or on a tape. Ta request, call 1-Sb0-342-5354 (DIAL-DLI) Voice or
TDD (6b1) 297-4198.
REI 01 (6/0�