P - 76947,�C,��-���-��
Minnesota Depart nt of Labor and Industry
443 Lafayette R, North ��+� , J U L 16 2407
St. Paul, MN 55-4342
Phone: (651 -5064
TTY/MRS: 1) 297-4198
www.ele iry.state.mn.us
Contractor/Re istered Em lo er Re uest for Electricai Ins ection
Da e Rough-In Inspection Required? ❑ Yes Single Inspection Other Than Rough-In: Ready Now
�� Contractor/Em lo er Must Schedule All Rou h-In Ins ections ConVactoNEm lo er Must Schedule All Final Ins ections ❑ Will Schedule
Address of I spection — Street City/Township Count �
� CP�' - �e �UC— �G2a� ��C-�-
Owner Name Project Description '
� 1'1�1 �S _ '
wner Tel phone Number(s) — Include Area Code(s) . �/�
4�� %�' Q�
ContractodRegistered Employer Name Contractor/Registered Employer Mailing Address
DEPENDABLE ELECTRIC 2619 COON RAPIDS BLVD
Contractor/Emqloyer Telephon� Humber Lontractc3:lEmplayer E-r.�ai� Address Eiectricat Utiiity
(763) 757-5090 info@dependableelectricinc.com
�C or/Employer thorized Signature Contractor License Number Job/Project Contact Person
CA02636 TERRY HARMON
Fee Calculation
Service/Power Supply 0— 400 ampere @$35 Technology System Devices ( )@ 75¢ Each
Separate Bonding Inspections for Swimming Pools and
Service/Power Supply 401 — S00 ampere @$60 E ui otential Planes $35 Each
Center Pivot Irrigation Booms ( )@$35 Each
Service/Power Supply Above 800 ampere @$100
__ __ _ Pi�s Elecirica! Drive Uuifs $5 Each
New/Extended Feeders/Circuits Up To 200 A( )@$6 Each Luminaire Retrofit Modifications ( )@ 25¢ Each
Feeders/Circuits Above 200 A ( ) Q$15 Each Concrete-Encased Electrode Inspection ( )@$35 Each
Investigative Fee $70 Or The Total Inspection Fee,
Reconnected Feeders/Circuits ( �@$2 Each Whichever Is Greater U To $1,000
Special Inspection Fee ( ) Hours Q$80 Per Hour
Manufactured Home Park Lot Supply ( )@$35 Each p�us Miles The IRS Milea e Rate of
Recreational VehiGe Site Supply Equipment Other
` Circuits Ori inatin in th$ E ui ment $6 Each
Street, Parking Lot, Lighting Standard ( )@$5 Each OV@f 6OO VOItS — Add the combined service/power supply and (eeder/dreuit fee to
result in double the regular fee (does not apply to electric sign and ouUine lighting)
( ) New Multi-Family Dwellings @ $70 Each
Transformers Up to 10 kva ( )@$15 Each With Up To 20 Feeders/Circuits '
Transformers Over 10 kva ( )@$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
6 Each
Electric Signs and OuUine Lighting � TOtal (the fee calculated above or $35 multiplied �
Transformers/Power Su lies $5 Each by the number of required inspecUon Vips, ��j ��
whichever is greater) •
Requests for Electrlcal Inspection (RE1) with a fee of 5250 or less expire 12 months from the filing date. The contractorlemployer must have the work
completed wlthln the 12 month period or submit another REI that includes the Inspection fee for the uncompleted work. Inspectlon fees do not carry over �
_ from one REI to another.
A service char e of 230 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
Finallnspection �> Date I
� __—� �� l �- � � 7
This materlal can be made available in different forms, such as large print,
TDD (651) 297-41'98.
REI 03 (6/07)
or on a tape. To
Voice or