P - 76836tJlinnesota D rtment �f Labor and Industry RESIDENTIAL ELECTRICAL PERMIT BY CONTRA.CTOR
443 Lafaye oad North PERMIT # i��� �%�✓�-e�
St. Paut, M 55155-4342
Phone: ( ) 2845064 RECEIVED: QGi��i �'1 C i� �/� �nn�
TTY/NiR (651) 297-4198 —�� -
www.el ricity.state.mn.us
Contractor Re uest for Electrical Ins ection — One Famil Dwellin lAssociated Structure
Date Rough-In Inspection Required? ❑ Yes Single Inspection Other Than Rough-In: eady Now
� �--' G�� ` V Contractor Must Schedule All Rou h-In Ins ections Contractor Must Schedule All Final Ins ections Will Schedule
Address of Inspection - Street C �wnship County
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wn r Name Projed Descripti ,
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Owner Telep ne Number(s) - Include Area Code(s)
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�6antractor Name Contractor Maiting Address
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Contractor Telephone Number Contrador E-mail Address Electrical Utilit
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C�n �ctor Autho e i nature Contrador License Number � Jo b/ Project Con t a c t Person �
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`� Fee Calculation
New Home or Associated Structure Existing Hom ructure Remodel or Addition
New Dwelling Service/Power Supply 0- 400 ampere @$35 New Service/Power Supply 0- 4�0 ampere @$35 `� �
New Dwelfing Service/Power Supply 401 - 800 ampere @$60 New Service/Power Suppfy 401 - 800 ampere @$60
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New Dwelling Feeders/Circuits New FeederslCircuits - Up to 15 Feeders/Circuits
U to 30 FeederslCircuits -$10D FeederslCircuits $6 Each or 16 to 30 $10D
New Home - More than 30 �eeders/Circuits (in addition to New Feeders/Circuits - More Than 30 Feeders/Circuits
above Feeders/Circuits U To 200 A $6 Each Feeders/Circuits U to 200 A $6 Each
Other (Specify) Reconnected Feeders/Circuits �
(� Feeders/Circuits $2 Each U
Detached Garage or Other Associated Siructure Detached Garage or Other Associated Structure
New Service/Power Supply 0- 4U0 ampere @$35 New Service/Power Supply 0- 400 ampere @$35
New Feeders/Circuits ( ) � $6 Each New Feeders/Circuits ( ) @ $6 Each
Other (Spec'rfy) Reconnested FeederslCircuits ( ) � $2 Each
Other (Specify) Other (Spec'rfy)
TOtal (the fee calculated above or $35 multiplied Tot31 (the fee calculated above or $35 multiplied �,<��
by the number of required inspection trips, by the number of required inspection trips, `�
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of f250 or less expire 12 months from the filing date. The contractor must have the work completed within
the 12 month period or submit another REI that includes the ins�rection fee for the uncompleted work. Inspection fees do not carty over from one REI to
another.
A service charqe of $30 will be added for all dishonored checks.
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This material can be made available in
TDD (651) 297-4198.
REI OZ (6/07)
� herem on me tlates s
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forms, such as larc
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or on a tape. To request, ca11 7-SOO-3az-5354 (o�rv�-uu) voice or