P - 75344_. 1 .
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' Minn�ota Dep nt ot Labor and Indusby
443 Lafayette oad North
st Paui, My-:�� �s�-aaa2
Phone: (65 284-5064
TiY/MRS: 651) 297�198
www.el ' .state.mn.us
_ contractoNRegistered Em
Rough-In InspeWon Requtred?
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idress Inspedion — Street
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Nner Name
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+mer Telephone Number(s) — clude
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�ntractoNRegistered Employer Name
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nt�actoNEmployer Telephane Numbe
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�er Request for Electrical
Yes Single Inspectlon Other Than Rouc
Ready Now
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�istered Employer Mailin Address r
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ntrac�cr Li�nse Number
C� �00 � y�
. Fee Calculatian
Service/Power Supply 0— 400 ampere @$35
ServicelPower Supply 401— 800 afnpere @$60
Service/Pawer Supply Above 800 ampere @$100
—Fee�er�s�Ci��p'r �0�/�—"—` ( 3 . � C� $8 Each ;
Feedevs/Ciraits Above 200 A (
Reconneded Feedets/Circuits (
Manufadured Home Park Lot Supp�y (
Street, Parking Lot, Lighting Standard (
Transformers Up to 10 kva � (
) @ $15 Each
) @ S2 Each
) C� $35 Each
) (a� S5 Each
) @ S15 Each
���5�
)?� Technology System DevfEes ( � � 7� ��
Separate Bondtng Inspedtons tor Swimming pccls and
E u' bential Planes $35 Each
Center Pivot Irrigatlon• Booms ( � � � ��
Plus Electrical �ive Unib $5 Eact
�h°' Luminaire Retrofit Modlflcatlons ( � � 2� ��
Concrete-Encased Etectrode Inspectlon ( ) @ $35 ��
( )
Over 600 Volts — aaa me m�a ,e��„p,,,�, ����� ��
re� in mutrls nia re�er rea (�es �s appy m mec� sig�, and ouffiro BgAtg+g)
( ) New Multf-Familv Dwellinac r� ��n cs..�,
With Up To 20 Feeders/Circuiis
TransfoRners Over 10 kva ( )@$30 Each ( ) Additional Circuits,4bove The 20 Aliowed Per Unit
S6 Each
Eledric Signs and Outline Lighting Tp�� ��e {� p�p�lated above or S35 multiplied
Transfarmers/Power Su lies S5 Each by the number af required inspecdon trips, ��
whichever is greater)
0
Requests for Eleetrical Inspeetlon (REl) whh a fee of SZSD ar leas expire 12 months }rom the flling date. The eoMraetoyem I
eompieted withln.the 1 o riad or submft another REI that tnclud� the ins P�Yer must have the w rk
��1 ���-�� pectlon fee for the uneompleted wark. Inspectlen {ees do not over
�' � A serviee eha e oi �i0 will l� dded for all dishonored eheeks.
I hereby csrtify that i inspected the electrical instailatlon herein on the dat� sqted: For Deparhnent Use Oniy
Rough — In Inspection(s) Date
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This matertal can 6e made available m dHfere�rt forms, sueh as large pNn�
TDD (6S1) 29T�198.
REI 03 (8/0�
����������
I�C'D MAY 0 9 200�
or on a tape. To requ�t, rall 1-80�;
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