P - 76959Minnesota D artment of Labor and Industry ,�� G%�
443 Lafayette oad North l•/ / �/��
St. Paui, MN 155-4342
Phone: (651) 2 5064 IIL�,r'D A�l G 2 4 200T
TTY/MRS: (651) 7-4198
www.eledricity.st .mn.us
ontractor/Re istered Em lo er Re uest for Electrical Ins ection
Date Rough-In Inspection Required? Yes Single Inspec#ion Other Than Rough-In: Ready Now
o�d- ��� � Contractor/Em lo Must Schedule All Rou h-In Ins ections Contrador/Em o r Must Schedule AII Final Ins ctions ❑ WiA Schedule ,
Address of Inspection — Street City/Township County •
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Owner Name Projed Description -
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Owner Telephone Number(s)— Include Area Code(s) �U�� Gdry fJ�,s��.tG�(
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Contractor/Registered Employer Name Contractor/Registered Employer Mailing Address
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Contractor/Employer Telephone Number Contractor/Employer E-mail Address Electrical Uti(ity
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Co ctor Employer A orize Sign ture Contractor License Number Job/Project Contact Person
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Fee Calculation
Seroice/Power Supply 0— 400 ampere �$35 Technology System Devices ( )@ 75¢ Each
Service/Power Supply 401 — 800 ampere �$60
Separate Bonding Inspections for Swimming Pools and
E ui oten6al Planes $35 Each
Center Pivot Irrigation Booms ( )@$35 Each
Service/Power Supply Above 800 ampere @$100
Plus Electrical Drive Units $5 Each
Feeders/Circuits Up To 200 A ( )�$6 Each Luminaire Retrofit Modfications
( ) @ 25¢ Each
Feeders/Circuits Above 200 A ( )@$15 Each Concrete-Encased Electrode Inspection ( )@$35 Each
Investigative Fee $70 Or The Total Inspection Fee,
Reconneded Feeders/Circuits ( ) @ $2 Each
Whichever Is Greater U To $1,OOU
Manufactured Home Park Lot Supply ( )�$35 Each Special Inspection Fee ( ) Hours @$80 Per Hour
� Plus Miles The IRS.Milea e Rate of
Recreational Vehicle Site.Supply Equipment Other
Circuits O' inatin in the E ui ment $6 Each
Street, Parking Lot, Lighting Standard ( )�$5 Each Over 600 Volts — naa o,e oomw�d ceM�� s„PPiy ana reedena�«,a ree �o
recult in doubk U» iegutar tx (doee not appy ro electric slgn entl outline �rjhtl�0)
Transfortners Up to 10 kva ( )�$15 Each ,� ) New Multi-Family Dwellings �$70 Each
With Up To 20 Feeders/Circuits
Transformers Over 10 kva ( )�$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
$6 Each
Eledric Signs and Outline Lighting TOtdl (the fee calculated above or $35 multiplied �
Transformers/Power Su lies $5 Each by the number of required inspection trips, ��� �
whichever is greater)
Requests for Electrical Inspection (REI) witti a fee of 5250 or less explre 12 months from the filing date. The contractorlemployer must have the work '
compfeted within the 12 month period or submk another REI that indudes the Inspection fee for the uncompleted work. Inspectlon fees do not carry over
nom one REI to another.
A service cha e of S30 wfll be added for all dishonored checks.
I hereby certify that I inspeded the electrical installation herein on the dates stated: For Departmerit Use Only '
Rough — In Inspection(s) Date
Fir�llhspection .—, Date
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This material can be made available in different forms, such as large prfnt, Breille or on a tape. To request, call 1-800-342-5354 (DIAI-DLI) Voice or
TDD (651) 297-4198.
REI 03 (6l07)