P - 76240Minnesota Departme of Labor and Industry
443 Lafayette Roa orth
Sti Paul, MN 5 5�342
Phone: (651) 5D64
TTY/MRS: ( ) 297-4198
wirowr.electri .state.mn.us
Homeowner
� Rough-In Inspedion Required?
� Homeovmer Must Schedule All Rc
�sp�tion — Street
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��D J U L- 9 2007
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uest for Electrical Ins
� y� InspeCtion Other Than
Insaections Homeowner Must Sch
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Owne� E-mail Address Electncai umtty /��
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By signing this document, I ce' that I am the owner as defined by Minn. Stat § 326.01 and will
Owner Sign�ure�� '
I. .
New Home or Associated Structur�
New Homa Servic�/Pawer Supply 0— 400 ampere @$35
New Home Senrice/Power Suppry 401 — 800 ampere @$60
Newr Home FeedersJCircufts
Feeders/Circuits -
New Home — AAore than 30
Each
Other
Fee Calculation
Detached Garage or Other Associated Structure
New ServicelPowrer Supply 0— 400 ampere @�i5
New FeedersJCircuits ( j � $6 Each
Ready Novw
V1fll Schedule
:s'�/ ��
the electrical work
Exlsiing Home/Strvcture Remodel or Addiiion
New Service/Powrer Supply 0— 400 ampere @$35
Newr 5eroice/Power Supply 401 = 800 ampere �$60
New Feeders/Circuits — Up to 15 FeederslCfrcuits
Feeders/Circuits $6 Eac� or 16 to 30 $100
iJew Feeders/Circa�its — More Than 30 Feealers/Circuits
(� 1 Feeders/Circuits Uo to 200 A(�D_ $6 Each
( ) Feeders/CircUfts � $2 Each �
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere �$35
Neav Feeders/Circuits ( ) @ $6 Each
Re�nneded Feeders/Circuits ( ) @ $2 Each
ToYdl (the fee calailated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, , by the number of required inspection trips, p�D e J�v
whichever is greater) whicheVet is greater)
Requests for Electrieal lnspectlon (RE1) with a fee of $250 or less ezpire 12 morths from the fllfng date. The owner must have the work completed wffhin the
12 mor►th period or submft another itEl that fncludes the Ir�p�Uon fee for the uncompleted work. InspecUon fees do not carry over from one REI to another.
A servlce c e of $30 will be added for all dlshonored checks.
I hereby certNy fhat I irupected the electrical install�atfon herein on the date.a stated: For Department Use Onty
Rough — In Inspection(s) Date
Final I
This material can bi
TDD (667) 297-4196.
REI 01 (6/D7)
forms, such�� large print, Brallle or on a
or