P - 75725Minnesota De
443 Lafayette
' St. Paul, MN
Phone: (651)
TTY/MRS: (6
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� Contrac
of Labor and Industry
?I) 297-4198
.state.mn.us
:or Re uest for Electrical Ins ection — One Famil Dwellin /Associat�
�, Rough-In Inspection Required? ye$ Single Inspection Other Than Rough-In:
� Contractor Must Schedule All Rou h-In Ins ctions Contrador Must Schedule All Final Ins ctions
ction - t City/T wn hip County
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Fee Calculation .
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dweliing Service/Power Supply 0— 400 ampere @$35 New Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60 New Service/Power Supply 401 — 800 ampere @$60
to
Feeders/Circuits
New ended Feeders/Circuits — Up to 15 Feeders/Circuits
ders/Circuits -$100 �FeederslCircuits $6 Each or 16 to 30 $100 s
(in addition to New/Extended Feeders/Circufts — More Than 30 Feeders/Circuits
)0 A(a� $6 Each ( ) Feeders/Circuits Ua to 200 A Ca� $6 Each
Detached Garage or Other Associated Structure
New ServicelPower Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
,
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Total (the fee calculated above or $35 multiplied TOtal (the fee calculated above or $35 multiplied �
by the num6er of required inspeEtion trips, by the number of required inspection trips, �S
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) wlth a fee of 5250 or less expire 12 months from the flling date. The contractor must have the work completed within
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.
f� � A servlce charge of $30 will be added for all dis nored checks.
� - `1%- � �l
1 hereby certify that I inspected the electncal installation herein on the dates stated: Fo� Depettment Use Only
Rough - In Inspection(s) Date �
This materla� be made avallable in dffferent forms, such as
TDD (651) 297-4198.
REI 02 (6/07)
�.vo� - C� ���
REC'D A P R 2� S 2008
or on a taae. To request, call 1-800-342-53
or