P - 76944C�" I
Minnesota Depa t of Labor and Industry
aas �atayeae Nonn
St. Paul, MN 155-4342
Phone: ( 2845064
TTY/MR (651) 297-4198
www. .state.mn.us
Contractor/Re istere
D e RougMln Inspection Required?
����//� ContractodEmpbver Must Schedule All
�s of Ins n— Street
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D�PENDABLE ELECTRIC
ConVactor/Employer Telephone
(763) 757-5090
u Yes �u,siE
i h-In I�s ections Contr
City/To
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Project
2619 COON RAPIDS BLVD
ContractoNEmpioyer E-mail Addre
�C'D J U L 2 3 2007
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for Electrical Ins
ction Other Than Rough-In:
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Address
Utitity
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p�(p�s ❑ WIU Schedub
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r/Empbyer Au rized Signature Contractor License Number �oar�ro�ecc c:ontact rE
CA02636 TERRY HARMON
- � - . Fee Calculation
Servioe/Power Supply 0— 400 ampere � S35 Technology System Devioes (
Servioe/Power Supply 401 — 800 ampere (� S60 Separate Bonding Inspec�tions for Swimm
E ui tential Planes
Servfoe/Power S-uppty Above 800 ampere � 5100 �nter Pivot Irrigadon Booms (
Plus Electrical Drive �
NewlExtended FeedsrslCircuits Up To 200 A( ) Q S6 Each Luminaire Retrofit Modificatlons (
Feeders/Cirouits Above 200 A ( )(� S15 Each Concrete-Encased Eledrode Inspecbon (
Reccnneded Feede�s/Circuits ( )(� S2 Each �nvestigative Fee S70 Or The Tofal Inspe�
Whichever Is Greater U To S1 000
Manutacbured Home Park Lot Supply ( )� S35 Each Special Inspection Fee ( ) Hours
Plus Miles The IRS Mil
o,.,.�..n.,....� v�.�..� es� e......�., e....:.....e..► r1N,nr .
( ) Circuits O�ipinatlng in the Equipment � S6 Each
Street, Parking Lot, Uphtlng Siandard ( )(gi S5 Each
Transforrners Up to 10 kva ( )(p� S15 Each
) � �5¢ Ead,
g Pods and
) (� S35 Each
) (� Z35 Each
) � 25¢ Each
) � :35 Each
��
Over 600 Volts — nm uie c«nbined seiv�carpaYVar auvpy arw �eaden«rxw lee w
result in aouo�e aie iepu�ar ree ldoes na appy w a�ecufc afon and aMNne YphbnO)
( ) New Multl-Family Dwellings (p� 570 Each
With Up To 20 Feeders/Circuits ' -
Transformers Over 10 kva ( )(� S30 Each ( ) Addidonal Circuits Above The 20 Allowed Per Unit �
6 Each '
Electric Signs and Outline Lightlng TOte) (the fee calculated above or S35 multiplied �
Transfortners/Power Su lies s5 Each by the number of required inspection trips, a� C�l
whichever is greater) �Jv
R�qu�s4s tor EbeWasl Insp�eUon (REI) with a i�� of i250 or less �xpin 12 months irom th� Hliny dats. Th� contraetwl�mploy�r must hav� tM work �
compl�Ud within th� 12 month pe�iod or submit another REI that includ�s the I�spection tee tor the uncomplebd wo►k. Insp�cGon tees do not carty ov�r
irom ons REI to another.
A saniu cha • ot =30 will b� add�d for all dishonorsd checks.
I hereby ceNiy that I inspected the electrical inslallation herein on the dates stated: For Depertment Use Only
Rouph — In Inspection(s) Date
n,is maaris� caa a
TDD (651) 297-4t88.
REI 03 (6/07)
Date I
/ 6 -% �]
tuch as lar� print, Bnille or on a tape.
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