P - 76958Minnesota D' partment of Labor and Industry
443 Lafayett Road North
St Paul, MN, 5155�342
Phone: (651 84-5�64
TTYIMRS: (6 ) 297-4198
www.electri ' tate.mn.us
ContractorlRe istered
Date ugh-In Inspection Required?
o�� ��� � Contractor/Em lo er Must Schedule Ali R�
Address of Inspection — Street
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Owner Name
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Owner Telephone Number(s) — Indude Area Code(s)
ContractodRegistered Employer �
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Contractor/Employer Telephone N
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Service/Power Supply
Service/Power Supply
Service/Power Suppfy
Yes
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REC'D AU G 2 4 2001
est for Electrical Inspection
Inspecfion Other Than Rough-In: � Ready Now
ictoNEmployer Must Schedule All Final Insnections n Wili Schedule�
City/Tovmship County
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Projed Description '
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�r/Registered Employer Mailing Address
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�r/Employer E-mail Address Electrical Utility
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Contractor License Number Job/Project Contact Person
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Fee Calculation
0 — 400 ampere � $35
401 — 800 ampere � $60
Above 800 ampere � $100
Feeders/Circuits Up To 200 A (
Feeders/Circuits Above 200 A (
Reconnected Feeders/Circuits (
Manufactured Home Par1c Lot Supply (
) @ $6 Each
) � $15 Each
) @ $2 Each
) @ $35 Each
Technology System Devices (
Separate Bonding Inspections for ;
Equipotential Planes (
Center Pivot Irrigation Booms (
Plus ( ) Electrical
Luminaire Retrofit Modfications (
) @ 75¢ Each
�g Pools and
) � $35 Each
) � $35 Each
nits (D_ $5 Each
) � 25¢ Each
Concrete-Encased Eledrode Inspection ( ) @ $35 Each
Investigative Fee $70 Or The Total Inspection Fee,
Whichever Is Greater Up To $1,OOU
Special Inspedion Fee ( ) Hours @$8� Per Hour
Plus ( ) Miles @ The IRS Mileage Rate of (
Other
Circuits Ori inatin in the E ui ment $6 Each
Street, Parking Lot, Lighting Standard ( ��$S EBCh OV2f 6OO VOItS — Add the combined s�vice/power supply and feededdrarit fee to
rewk in doubk the regutarfee (does not appy to electric sign and outline Gghting)
Transformers Up to 10 kva ( )@$15 Each �� ) New Multi-Family Dwellings @$70 Each
With Up To 20 FeedeFs/Circuits
Transfortners Over 10 kva ( )�$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
$6 Each
Eledric Signs and Outline Lighting TOtal (the fee calculated above or $35 muftiplied
) Transformers/Power Su lies $5 Each by the number of required inspection trips, ��� ��
whichever is greater)
Requests for Electrical Inspection (REI) with a fee of 5250 or less expire 12 months from the filing date. The co�rtractorlemployer must have the work
completed within the 12 month period or submit another REI that includes the inspection fee for the uncompleted work. Inspection fees do not carry over
from one REI to another.
A service char e of S30 will be added for all dishonored checks. �
I hereby certify that I inspeded the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
Inspection
i nis maLena� can �i
TDD (651) 297-4198.
REI 03 (6/07)
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as large �
or on a tape. To request, call 1
or