P - 76957Minnesota Departrnent of
443 Lafayette Road No
St. Paul, MN 5515 2
Phone: (651) 2
1'TY/MRS: (65 7-4198
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ress of Ins{
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and Industry
Request for Electrical I
Rough-In Inspedion Required?
Contractor Must Schedule All Rougl
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. . REC'D S E P 7 2007
— One Famil Dwellin /Associat��! Structure .
Singie Inspection Other Than Rough-In: �—�Ready Now •
Contractor Must Schedule All Final ins ections „�,� Will Schedule
CityfTownship County
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Electrical Utilitv .
ctor License Number
CAola-23
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere Q 535
New Dweiling Service/Power Supply 401 — 800 ampere �$60
- $100
New Home — More than 30 Feeders/Circuits (in a
abovel f ) Feeders/Circuits Uo To 200 A
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere (dl $35
New Feeders/Circuits ( ) (a3 $6 Each
dProjed Contact Pers ;
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F�cisting Home/Structure Remodel .idditlon
New Service/Power Supply 0— 400 ampe� .,., $35
New Service/Power Supply 401 — 800 amp� .,$60
ars/CErc�i.s — Up to 1� Feeders/C+rcuiEs
Feeders/Circuits �$6 Each or 16 to 30 ( a
�rs/Circuits — More Than 30 Feeders/Clrc� .ts
1 Feeders/Circuits Un to 200 A C� S6 E�:
( ) Feeders/Circuits � 32 Each �
Detached Garage or Other Associat�^i Structure
New Service/Power Supply 0-400 ampere "$35
New Feeders/Circuits ( )@ 36 E� h
Reconneded Feeders/Circuits ( ) Q S2 Esu•h
- - - - ,$'H: i�Lir aa � '
Totel (the fee calarlated above or $35 multiplied � TOtal (the fee calculated above or $35 multiplied
by tha number of requfred inspedion trips, by the number of required inspection trips, 7Q ��
whichever is greater) whichever is greater) ..
Requests tor Eleetricai InspacUon (REI) with a fee of 5250 or less expire 12 months from the flling date. The contractor must have the : compisted wifhln ,
ths 12 month peflod or submk anothsr REI that includes the Inspection fee for the uncompletsd work. Inspeetion fees do not carry Irom on� REI to
another.
A aervice eharge of S30 will be added for all dishonored checks.
I hereby cerdfy that I inspected the elecUiql installation heretn on the dates stated: For Department Use Only
Rough - In Inspection(s) ��.� Date
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This mabrlal can be mads available in different fom�s, such as large print, Braille or on a
TDD (6d1) 297-4198.
REI 02 (6/0�
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