P - 75658Minnesota Depa ,' of Labor anc! lndustry
443 Lafayette Roa�' orth
St Paul, MN 551, 342
Phone: (651) 2 5064
TTY/MRS: ( ' 297�4196
www.eledri ' .state.mn.us
Cont tor R uest for Electrical In
Date Rough-In Inspection Required?
�- / Cantractor Must Schedu{e Ap Rou Ir
Address of Irispection - StrPef
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Owner Telephone Number(s) - Indude
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C�ntractor Name
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Contractor Telephene Number
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Contractor Authcr¢ec�. Signature
RESIDENTIAL ELECTRICAL PERMIT BY CO(dTRACTOR
PERMIT #
RECENED:
tion — One Famii Dwellin /Associated Structure
y� Single InspECtion Ofher Than Rough-In: Ready Now
rctions Conbactor Must Schedule All Final Ins 'ons [� Will Sch�ule
CitylTownship County
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Projed Desc�pfion
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Contractor E-mail Ac
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�`'S °�" S��ef'� a �'�'t �
, Electric�l Utility
Cor�tac:t Person
- o�t��
/ Y �% Fee Galculation
New Home or Assoclated Structure Existing Home/Shvcture Remodel or Addition
New Dweliing Servica/Power Suppiy 0- 400 ampere �$35 Neav Servis�/Power Suppiy 0- 400 ampere �$35
New DwelGng Service/Power Suppy 401 - 8D0 ampere @$60 New Senric�/Pov✓er Supply 401- 8Q0 ampere �$60
New Home - More
�its (in
To 20D ,
_
Each
New Feedets/CiFCUits - Up to 15 FeederslCircuits
�pp FeederslC'u�arfts $6 Each or 16 to 30 $100
Rlew Feeders/Circuits - Allore Than 30 Feeders/Circu�s
t t FeederslCirca�ffs Uc to 200 A(a� $6 Eech
Detached Garage or Other Associated Structure
New SenrfcelPower Supply 0- 400 ampere �$35
New FeedersJCircuits ( ) @ $6 Each
Other (Specify)
Other (Speafy)
Detached Garage or Other Associated Structure
New Servfcc,�e//Power Supply 0- 40U ampere �$3b
New FeedersJC'va�its ( ) @ $6 Each
Reconneeted FeederslCircuits ( ) @ $2 Each
Total (the iee calculated above or $35 multiptied Totd) (the fee calculated above or $35 multiplied
by the number of required inspedfon t�ips, by the number of required inspec#fon trips, �� S^�
whichever is greater) whichever is greater)
Requests for Elettrical lnspection (REI) with a%e of $25D or less explre 12 montt� from the flpng date. The cor�'actor must have the work completed wlthin
the 12 month period or submft arwther REI that includes the fnspectlon fee for the uncompteted work. Inspectlon fees do not carry over from one REI to
another.
A serviee charge of $30 wlli ba add� for atl dishonored ch�ks.
I hereby celtHy that I inspede� - . - . . . • ••-..-- `--'- -- "-- �-•-- .,•_.,..�. Fnr Daeartment IJsg Onlv
Rough - In Inspedion(s)
This material can be made avaflable in different
TDD (651) 297-4196.
REI 02 (6/07)
Date
Date
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such as large pr
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or on a Yape. To request, call 1-SQO-3�
Voice or