P - 75436� , � �6`7 �-�`1 � 7`�
� Minnesota De ent of Labor and Industry JUL 1� ZOO7
443 Lafayette d North ��
St Paul, MN 15r4342
Phone: ( 284-5064
TTY/MRS• 651)297-4188
www.el c�ly.state.mn.us
Contractor/Re istered Em lo er Re uest for Electrical Ins ection
Date Rough-In Inspecdon Required? � ye3 Single InspecUon Other Than Rough-In: Ready Now
J% 9 I ContractodEm 1 r Must Schedule All Rou h-In Ins ons ContradoNEm lo er Must Schedule Ail Flnal Ins edtons ❑��edule
Addr�s of InspecUon - Street City/Town hip Ccu
-� c�a� G � �U �
er Name Project Descrip on
�� �I
Owner Telephone Number�s) - Include Area Code(s) : ��/� GLL� �
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Contractor/Reg[stered Employer ame GontradoNRegfstered Employer MaUing Address
DEPENDABLE ELECTRIC 2619 COON RAPIDS BLVD
Contt�acto�r�p{eyer�T�lephsr�e-NumbeX Q�EmailAddress _,_ __ Electrical Utility
(763) 757-5090 info@dependableelectricinc.com
Contra NEmployer Auth rized Signature Contractor License Number Job/Project Contact Person
CA02636 TERRY HARMON
Fee Calculation
Service/Power Supply 0- 400 ampere @$35 Technol�y System Devicas ( )@ 75¢ Each
Separate Bonding Inspec8ons for Swimming Pools and
SeMce/Power Supply 401- 800 ampere @$60 E ui tentlal Planes $35 Each
Center Pivot Irrigatlon Booms ( ) aQ $35 Each
Servic�/Power Supply above 800-amp�re a�,7$'t�0 — - --- - - ----
� Plus Electrical Drive UNb � -�5- .E-'ach"� �
New/Extended FeedersJCirouits Up To 200 A( )@$6 Each Luminaire Retroflt Modificatlons ( )@ 25¢ Each
Feeders/Ciraiits Above 200 A ( )@$15 Each Concaete-Encased Electrode Inspedion ( )(� $35 Each
InvestlgaUve Fee $70 Or The Total InspecUon Fee,
Rec�onneded FeedersJC(ra�its ( �@$2 �� yyhichever Is Greater U To $1 000
Manufadured Home Paric Lot Supply ( )@$35 Each Spedal Inspedion Fee ( ) Hours Q$80 Per Hour
Plus Miles The IRS Milea e Rate of
Rec�eadonal Vehicle Site Supply Equipment Other
Circuits Ori nadn In the E ui ment $6 Each
Street, Parking Lot, Ughtlng Standard ( 1@$5 Each Over 600 Volts - naa nre � se�ce+ao�er euvNr � r�� ��
result in doubte tlre reguiar tee (does irot appy to eieetr� efgn end autl6re 69htln9)
( ) New Muld-Famlly Dwellings @ $70 Each
Transformers Up to 10 kva ( )@$15 Each
With Up To 20 FeederaJCircuib
Transformers Over 10 kva ( )@$30 Each ( ) Additlonal Circults Above The 20 Allowed Per Unit
6 Each
Electric Signs and Outline Lightlng TOtel (the fee calarlated above or $35 mulUplied a� ��
TransformerslPower Su Iles $5 Each by the number of required inspection Mps, ,
whichever is greater)
Requests for Eleetrical Inspection (REI) w(th a fee oi f'150 or lesa expire 72 months irom the flling date. The eontractoMemployer must have the work
completed within the 12 month penod or submtt another REI that includes tha InspecUon fee for the uncompleted work. InspecUon fees do not carry over
-��� trom one REI to another.
A service cha e of s30 will be added for all dishonored checks.
I hereby crertffy that I inspeded the electrical installadon herein on tFre dates stated: For Department Use Only
Rough - In Inspection(s) Date
s�JG/ ��/�_
Final l�pe�lon Date
- �j�s < i e �
This materlal can be made avaitable in dHtereM fomts, such as large print, Braiile or on a tape. To request, call 1-800.342-5354 (DIAL-0LI) Voice or
TDD (851) 297-4T98.
REI 03 (6l07)