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P - 75643_� Minne�ta of Labor and Industry 443 Lafay Road Narth . . St Paul, 55155�342 Phone: 1) 284-�4 TTY/M . (651) 297-d198 www•e �atY-state.mn.us Conl�actor R uest for Ele�ctrical In �e RougtMn Inspedion Requined? Cor�r Mu,st Sdtealule Ntl Address of I�pection - Str+eet ��1� �r�� ah s� s � Owner Telephone IVumber(s) - Indude A CoRtrador Name�� L �S'r/ � �,�' %/,� � 7�� >r. cormacEor�' elepnate Pl�un� �S�-�id�9% �` �I �� 6� �� nihactor Lic �� ion — One Famil Dwellin Yes S�e ��A�� ' Than F �iions Conhac�Or AAust Sct►pdub Aq F �r�/-� P� �iption �� - S� � Gi (� `� �� . � Ready Now Vlftll �u �� o �f� S�lrU /C'�e �0 Fee Calculation New Hame or Associat�d Sl�r.t�ne Ex�tirtg HomB�Stru�re Rerrtodel or Addition IUeutr D�eQing Servic�eiPower Suppty 0- 400 ampere a� $3,5 New ServicpJPa�wer SuPPjY �- 400 am�re C� $35 Idew �rtg Servic�/Posa�r Supply 401- 8� ampeie @� N�nr Ssroice/Po�ner Suppty 409 - 800 ampere @�0 (��yy - --- — - NewJE�ended Feeders/['� �c _ � �., �., � a rm..e.�.�:.....�.. �[�c.� r�a. �,E.. i�. ��. - More Detached Garage ar Other Associa� Sbvcture Ne�v Senric�e/Pawer Supply 0-� ampere �� Odew Fe�ers/G'vcui�s ( ) @ $'6 Each 16 to 30 � Feed A C� S6 Detacl�l Gardge or Other Associa�! Str��h�e � �°�T �RF�Y 0 - 400 am�r� @ $35 N�vr/E�der� Feeders/Ctrwits ( ) �a3 $6 Eat�i Reaonrtec*ed F�dersJCiraiit� ( ) c� $2 Eech Total (U� fee calaila� abave or $3,5 multipl� Tot�l (the fi� calailatQd above ar $3S multipU�d by the number of r�uined ir�on tri�rs. whid�ever � greatier) �whichever � 9r�eate�� n �' ,j � Re9u�ffi for Elect�cai I� (�1 v� � feea� �0 or less ez�re 12 � tr� � I t➢�e 12 mar��h period orsuimt� a� �� inctudes tl� i�on f8e for tl�e � date. The corrtracLor m�t have tlee wark omnplebecl within another. M�� +�P�� iees do rrot carry over irmn one REI� A� charge af S30 �erH! be� t�' 8A d€s�nor�ed ci�[cs, � � ��Y �Y � � � tl� e�tical �1alia6� i� an 6�a d�es �atecl• . Rough - In lr�pecfion(s) r--�---� - -- - - Th� rr�terial can be � aval�te in TDD (651) �7�1�. REI 02 (6/07) 0 suci� as large Pr�rn, � �� — �� L � �cro � u � i g 200� or on a fape. To re9+� caq 1-8�342-53& Volr.e or