P - 75507Minnesota Dep riment of Labor and Indus6y
443 Lafayeite ��oad North
St Paul, MN ��55155-4342
Phone: (65 284-5D64
TTY/MRS: 1) 297-4198
wvvw.el ity.state.mn.us
Con ctor R uest for Electrical Ins E
Date Rough-In InspecEion Required?
�- ""� Contrador Must Sct�edu{e A(I Rou h-In In�
Add of Insp�c#ion — Street
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Contractor
New Home or Associated Structure
Plew Dwe[iing Sen+i�/Power Suppy 0— 400 ampere �$35
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RESIDENTIAL ELECTRICAL PERMIT BY CONTRACTOR
PERAAIT # � CS a a' U((P�
RECENED: `�� � z � � �T
— One Famil Dwellin /Associated Structure
Singie Inspec�i�n Other Than Rough-In: � Ready Now
Cnntractor Must SrJ�edule All Final Insnections n WiA Schedule
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Fee Calculation
New Dwelfirtg Senrice/Prnroer Supply 401 — 80D ampere ��60
'C'ur:uNs - 5100
Home — More than 30 Feeders/Cira�its (in addition to
el ( 1 Feeders/Circuits Uo To 200 A Co� $S Each
Detached Garaae or Other Associated Structure
idew Service/Power Supply 0-4� ampere @$35
New Feeders/Circuits ( ) � $6 Ea�
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Person
Existing Home/Structure Remodel or Addition
New Senrice/Power Supply 0— 400 ampere @$35
New Senri�/Power Supply 401— 8D0 ampere �$60
+ders/Cira��s @$6 Each or 16 to 30 �$1
'Circuits — More Than 30 Feeders/Cirwits
) Feeders/Circuits Up to 200 A@$6 Each
FeederslCircuits
Detached Garage or Other Associaied Structure
New Service/Pouver Suppiy 0— 400 am�re �$35
New Feeders/C'vcutts ( ) @ $6 Each
Reconnesied Feeders/Circuits ( ) � $2 Each
Total (the fee calculated above or $35 mulNpGed To�'dl (the fee calculated above or $35 multiplied �
by the number of required inspedion trips, by the number of required inspedion trips,
whichever is greater) whid�ever is greater)
Requests for Eledrital Inspeetion (REt) with a%e of $250 or less e�lre 12 months from the flHng date. The coMractor must have the work completed w 4i�
the 12 montl� �riod or submk another REI that Indudes the inspectlon fee for the uncompteted work. lnspectlon fees do not carry over from o ��`�
another. �/
A servtce charge of $30 will be added for atl dLshonored eh�ks.
I hereby certlfy that I mspected the el�trical installation herefn on fhe dates stat�: For Department Use Oniy
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TDD (651) 297-4796.
REI 02 (6/07)
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