P - 75478I
Minnesota Departm
443 Lafayette Road
St. Paul, MN 5515r
Phone: (651) 28
TTY/MRS: (651 5
www.electriciN atE
Labor and Industry
Co tractor. Re uest for Electrical Ins
Rough-In Inspection Required?
O� Con ctor Must Schedule All Rou h-In
Add��,ef��ection S��t� � �
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New Home or Associated Structure
New Dwelling Service/Power Supply 0– 400 ampere @$35
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;ction — One Famil Dwellin /Associated Structure
] Yes Single Inspection OtherThan Rough-In: � Ready Now
ections Contractor Must Schedule All Final Ins ections Wiil Schedule
City/T��dvQ��ip„ (/''�� — Coun �� �� A �
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Project scription
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Fee Calculation
New Dwelling Service/Power Supply 401 – 800 ampere @$60
ta 30 Feeders/Circuits -
New Home – More than 30
To 200 A la� $6 Each
Other (Specify)
Detached Garaqe or Other Associated Structure
New Senrice/P.ower Supply 0— 400 ampere �$35
New Feeders/Circuits ( ) @ $6 Each
Other (Specify) •
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Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Serv(ce/Power Supply 401 — 800 ampere @$60
New Feeders/Circuits — Up to 15 Feeders/Circuifs
Feeders/Circuits $6 Each or 16 to 30 $700
New Feeders/Circuits — More Than 30 Feeders/Circufts
( ) Feeders/Circuits U� to 200 A�$6 Each
( ) Feeders/Circuits @ $2 Each I
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied �� ���
by the number of required inspection trips, by the number of required inspection trips, �
whichever is greater) whichever is greater) •J�
J
Requests for Electrical Inspection (REIj wtth a fee of 5250 or less expire 12 months from the ftling date. The contractor must have the work completed within
the 12 month perfod or submft another REI that Includes the Inspecdon fee for the uncompletsd work Inspecdon fees do not carry over from one REI to
another. � � ��
A service charge of $30 wtll be added for all dishonored checks.—
I hereby certify that I inspected the el�;trical installatlon herein on the dates stated: For Departrnent Use Only
Rough – In Inspection(s)
This material can bi
TDD (651) 297-4198.
REI 02 (6/0�
Date
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:, such as la
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REC'D S � P 0 � �008
or on a tape. To request call 1-800-342-5364
or