P - 76233Minnesota Department of Lebor and Industry
443 Lefayette Road North
St Paul, MN 55155-4342
Phone: (851; "�84-5064
TTY/MRS• 51) 297-4198
www.el city.stete.mn.us
Co tractor Re uest for Electrical
Dete Rough-In Inspedion Requlred?
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�Qntrector Name
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��'D JUL 10 2007
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her Than Rough-In: Ready Now
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Contractor Matling Addresa
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Contrector Ltcense Number
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Fee Calculation
New Home or Assoclated Structure
New Dwelling Service/Power Suppiy 0— 400 ampere �$35
N��Dweliing - -G $60 -�- - _
to 30
09fS/VIfGUI[S' �
(in add(Uon to
)0 A Ca� S6 Each
Detached Garage or Other Assoclated Structure
Near SeMce/Power Supply 0— 400 ampere @$35
Nsw FeederslClrcufts ( ) (a3 $8 Eech
Person
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Existing Home/Structure Remodel or Additlon
New Servics/Power Supply 0— 400 empere �$35
iUeat ServlcelPoorer-S�PP�Y— 4t1'� - 809 empere ��60 -
New/Extended Feeders/Cira�ts — Up to 15 Feeders/CircuRs
Feede�s/Circ�its $8 Each or 18 to 30 $100
New/Extended Fesders/Circuits — More Then 30 Feedera/Circ�its
i� 1 Feeders/Circutts Ue to 200 A Co� $6 Each
Detached Garage or Other Assaciated Structure
New Servics/Power Supply 0-400 ampere �$35
New/Extended F�derslC(rcuits ( ) Q $8 Each
Reconne�ted Feeders/Ctraiita ( ) @ $2 Eech
Totel (the fee celculeted above or $35 multlplied TOt81(the fee c�laileted above or $35 multlplied
by the number of required tnapecUon trips, by the number of required InapecUon tr�ps,
whichever is greater) whlchever is greater)
Requasts for Eleatrical lns�ctlon (REI) wtth a tee ot a280 or laes expire 12 moMhs haom !he tiUng date. The coMraetor must heve the work teb
tl�e 12 momh per�od or aubmlt anather REI tlY�at includea the i�peat�on fee for the un�mpleted wak. lnapectlsn fees do rrot cerq► over from one
another.
A sarv�ce charge of 830 wiU ba added ior ali dishorrored checks.
I herebvi cerdflr that I h�saected the electrical inatalladon hereln on the detea steted: For Depertment Use Only
Rough — In Inspectfon(s)
Inspection
rma matena� can �
TDD (857) 287-4188.
REI 02 (8/07)
Date
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