P - 75354Minnesota D,ep�rtment of Labor and Industry
443 Latay�ff� Road North
St Paul, N 55155�4342
Phone:, 1)284-5064
1"fY : (651) 297-4198
www. 'city.state.mn.us
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for Electrical
� Rough-In Irtspectian Required? �i° 5 U Yp,g Sh�gle Insp�ion Other Than Rough-In: U�� N�
���`D � Contrad o Must Sdredule M Rou h-In Ins CoritraQodEm o Mt�st Schedule All Finad I 'ons I�I �i Schedule
Address of I�pedion — Street Cit�rlfownship Courrty
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OMmer Telephone Number(s} — Indude Area Cade(s)
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COUNTRYVIEW ELECTRIC INC.
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8414165TH AV NE. FOREST LAKE MN. 55025
Contrador/Employer E-mail Addr�s Eledrical Util'dy
Liaense
Fee Calculation
SenrloelPower Suppy 0— 400 amper� (a� $35
SemloeJPomrer Supply 401— 800 ampere (83 $60
Servlc�//Power Supply Above 8� ampere �$100
NewdExtended Feeders/CirCU�s Up To 2� A( )@$s �aa,
Feeders/Circ�fts Abcve 200 A ( )�$15 Eadi
Recc�nnneded Feeders/Circuib ( �v ) (� $2 Each
Manufacxured Home Park Lot Su�ly ( )(c� $35 Each
( ) Ciroqiits Od9inatln9 in the EQUiPmBnt @$6 Ead�
Street, Padcing Lot, Lightin9 Standard ( )�$5 Each
Transformers Up to 10 kva ( )�$15 Each
�
MARK
T�hnot�y System Devioes (
(
Luminaire Rehofit AAodfications (
Concxete-Encxised Elec�rode Irnspection (
Imr�ative Fee $70 Or Tha Total insoe�
)
Plus
) C$ 75¢ Each
ig Poals and
) (� $35 Eac�t
) C� $35 Each
nits C� �5 Eac�
) @ 25¢ Each
) @ $35 Eadt
ee,
I Per Wour
tate of (
Over 800 Volts — n� ure oommnea ��er eu�y � re�enma�atee eo
reaua � d�e are t�t�rw �cbes noc eppy to memie d�, ana ou� �ghurre>
( ) Neaa Multl-Famiiy Dwelihtgs � $70 Each
U1� Up To 20 F�ders/Circwits
Transformers Over 10 kva ( j�$30 Each ( ) Additlonal Circuits Above The 2p Allornr�l Per Unit
Eacd�
Electria Signs and Outlirte Lightirtt� Tot�l (the tee calca�lat� above or $35 multiptied
Transforrt�rslPo�r S lies $5 Each by the number of r�equired inspedian tri�,
�icl�ever is ereater)
� w a inE�morMb� �od" t�rsu�iun� ��i � u►c�� ihe ��� ree�ro� t�fre um��.om�ebea w�u� � must have me
P� P�o� � � � ca�
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�� Rrrvoy a�rury u�[ i mspec�eo u�e e�Cmct�l mBlauaqOn nereln On tlte tl�D2s st8tetl: �� ��p���
Rough — In Inspec�on( p�
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Fnal Insp�tion pe� C'�— � � �
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Th� rr�r�i can be availabte In dlHsrer�t fomm, such � large pri�, Bratqe or on a tape. To �uest, caii 1,8Q0�42-b364 (DIAL-DLq Volc� or
TDD (651) �7-4188.
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