P - 75576Minneso� pepartment of Labor and Industry
443 Lafayette Road �, orth
St. Paul, MN 551 342
Phone: (651) 2 ' 5084
TTY/MRS: (6 287-4198
Date • Rough-In InspecNon Required?
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Address af Inspectlon — Street
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Ov►mer Telephone Number(s) — incwde A
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ContractorlRegistered Employer al�
SUBURBAN ELECTRIC, INC
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14800 28TH AVE N, SUITE 125, PLYMOUTH, MN 55447
:ontrectorlEmolover E-mail Address Electrical UUlitj+
7�-�98-729 �
ContractodEmployer Authoriaed Signature Contractar Uc�nse Number JabA
� � `�� �t �O CA02503
- Fee Calculation
Servlce/Power Supply 0— 400 ampere �$35 Technotogy System Devices
" Separate 9einding Inspectlon�
Servlce/Power Supply 401— 800 ampere (d1$80
E ui otential Planes
Center Pivot Irclgatlon eooms
Service/Power Supply Above 800 ampere �$100
Pkis E{ec
ject Contad Person
( ) @ 75¢ Each
Swimming Pools and
( ) @ $35 Each
( ) Q $J5 Each
New/Extended Feeders/Circuits Up To 200 A( ) c� $6 Each Luminaire Retroflt Modf�ca8ons (
Feeders/Circ;uits Above 200 A ( )@$15 Each Concrete-Encased Electrode Inspection (
Investlgative Fee $70 0� The Total Inspei
Reconnected Feeders/Circui� ( ) (� $2 Esch
Whichever Is Greater U To $9,000
Special InspecUon Fee ( ) Hours
Manufactured Home Park Lot Supply ( ) ue $35 Each p�us ( . 1 Mlles Ca� The IRS Mn
) @ 25¢ E�ch
) (a� $35 Each
L
Rate of
Street, Psrking Lot. UghUng Standard ( ) C� $5 Each �em ��e �►�d�rdea td os r��c apah ro�� �e �d ou�� �ie� r« m
� ( ) New Muld-Family Dwellings (D $70 Each
Transfortners Up to.10 kva ( )�$15 Each
With Up To ZO Feeders/Circufts
Transformers Over 10 kva ( )�$30 Each ( ) Additlonal Circults Above The 20 Allow� Per Unit
Each
Electric Signs and Outline Ughting TOtel (the fee c�lc�lated above ar $35 multiplied
Transformers/Power Su Ifes $5 Each by the number�of required inspectlon Mps, 3� )�
whichever is greater)
Reqttests for Elaclrleal Inspactlon (REI).with a tee of S2L0 or less expire 12 mo�rths troin the flqng date. The aontreotoHert�ployar must have the work
completed wRhin the 12 month period or aubmR anothsr REI tl�et h�cludes the htspectlon fee tor dte uncompleted w�k. I�pecUon not carry over
from one REI M enother.
`�`` f f- fi D A service ehe e oi S30 wlp be ad�d (ar all dishonbred eheeks.
I hereby csrtlfy that 1 inspeoted the elecMcal Instellallon hersin on the dates steted: For Departrnern Use ly
Rough — In Inspedion(s) Date � � j, � �� I � �� �
llti . .�'`
-�-�� I ��ro JUL �� �'
h�s large prlr�t, Brai��e or on a tepe. To requast,
TDD (8S1) Z97�198.
REI 03 (8/07)
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