P - 75661Minnesota Depart{nent of Labor and Industry
443 Lafayette Rg`�d Ncrth '
SL Paul, MN 55�15�4342
Phone: (651),��84-5�4
TTY/MRS: (�1)297-4798
Date
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Address of Ins�
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Owner Name
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Ccr�trador Nai
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Request for Electrical
Rough-In Inspedion Required?
Contrador Must Schedule All Rou
ion - Street
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M�mharfcl — Induda Area CodB(s'
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Yes
�t��1��NTIAL ��E�CT�tCA�L�PERMIT BY CONTRA.CTOR
P�RAAIT #
Ft�6�N�D: i r�m I I I 1 1� nno
— ��te Fa�it Dwellin IAssoc�ai�d Str�ct�re
Single Inspec�ion Other Than Rough-In: Ready Now
Cor�trador Must Schedule All Final Insaections � Will Schedule
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Contractor E-mail Address Electrical Ub iry
yi`/�.rRA,`�Qc;�► i•,o►:� .�..a�s
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Con dor License mber • Job/Project Contact Person
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Fee Calculation
New Home or Assoclated Structure Existing Home/Structur8 Remodel or Addition
. New DwelGng Senrica/Power SuPPIy �- 400 ampere @$35 New 5enrice/PoHVer Supply �- 400 ampere @$°:5
New Dwelling Senrice/Power Supply 401- 800 ampere @>, $6.0 New 5en►ice/Power Suppy 401- 800 ampere @ S60
---- - ' ' � �Cirauita
ew e mg F�rsJCircu�s — --- — — - _ _ _
U to 30 FeederslCircuRs -$100 Feeders/Cira�its $6 Each or 16 to 30 $1 DO
New Home - More than 30 �eeders/Grc�its (in additfon to New FeedersJCircuits - More Than 30 FeederslCircuits
To 200
Detached Garage or Other Associated Structure
New Service/Power Supply 0- 400 ampere @@ $35
New Feeders/Circuits ( ) � $6 Each
FeederslCircuits U to 200 A $6 Each
Reconneded Feeders/Circuits �
� FeederslCtraits $2 Each
Detached Garage or Other Associated Structure
New Servic�/Power Suppy 0- 400 ampere @$35
New FeedersJCircuits ( ) @ $6 Each
Recxnnested Feeders/Circuits ( ) @ $2 Each
Other (SpecifY)
Total (the fee calr.ulated above or $35 muttiplied Total (the fee calc�ulated above or $35 multiplied �� 1
by the number of required ins�ctlon trips, by the number of required inspedfon trips, ��
wh�chever is greater) whichever is greater)
Requeste for Electrisal Ins�on (REI) with a fee of $250 or less expire 12 moriths from the RBng date. The conb�actor must have the work completed within
the 12 mornh period or submk another REI that indudes the Inspectlon fee for the uneompteted work. Inspecdon fees do not carry over from one REI to
another.
A servies charge of E30 will be added for all dishortored checks.
Rough - In Inspection(s)
This material can bi
TDD (651) 297-4198.
REI 02 (6J07)
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Voice or