P - 75437Minnesota Depa ent of Labor and Industry
443 Lafayette d North
St. Paul, MN 155-4342
Phone: (651 84-5064
TTY/MRS: 51) 297-4198
www.elect ity.state.mn.us
Contractor/Re istered Em I
Date Rough-in Inspection Required? �
��� U" �. I Contractor/Em lo er Must Schedule All Rou h-In In:
Address of Inspection — Street
�C�C,�O Cw�.trvc�.i.. �.� . Y�- .
Owner Name
PARSONS ELECTRIC
(763) 571
Yes
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REC'D OCT 18 2001
uest for Electrical Insuection
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— Include Area Code(s) I��"����� ��`''� ��� �� e G�"� �"
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Name
Contractor/Registered Employer Mailing Address
5960 MAIN STREET NE, MINNEAPOLIS, MN 55432
Contractor/Employer E-mail Address Electrical Utility
com
Job/Project Contact Person
CA03573 "r(�'�� �Y ,�,�
Fee Calculation � �-- � � -
Service/Power Supply 0— 400 ampere @$35 Technology System Devices ( )� 75¢ Each
Service/Power Supply 401 — 800 ampere @$60 Separate Bonding Inspections for Swimming Pools and
E ui otential Planes @$35 Each
Service/Power Sup�y Above 8 O(l�m�er�a � _ Center Pivot Irrigation Booms ( )@$35 Each
Plus Electrical Drive Units $5 Each
New/Extended Feeders/Circuits U To 200 A �
p ( �(�}} )@$6 Each /1(3� Luminaire Retrofit Modifications ( )@ 25¢ Each
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Feeders/Circuits Above 200 A ( )@$15 Each Concrete-Encased Electrode inspection ( )@$35 Each
Reconnected Feeders/Circuits ( )@$2 Each Investigative Fee $70 Or The Total Inspection Fee,
Whichever Is Greater Up To $1 000
Ready Now
Will Schedule
Manufactured Home Park Lot Supply ( )@$35 Each
Recreational Vehicle Site Supply Equipment
( ) Circuits Originating in the Equipment @$6 Each
Special Inspection Fee ( ) Hours @$80 Per F
Plus ( ) Miles Ccil The IRS Mileaae Rate of
�
Street, Parking Lot, Lighting Standard ( )@$5 Each OV@� 6OO VOItS — Add Uie combined servf�/power supply and f�deddreuK fee ro
result in double the regutarfea (does not epply ro etectrlcsfgn and ouUine lighting)
Transformers Up to 10 kva ( )@$15 Each � ) New Multi-Family Dwellings @$70 Each
With Up To 20 Feeders/Circuits
Transformers Over 10 kva ( )@$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
6 Each
Electric Signs and Outline Lighting TOtal (the fee calculated above or $35 muitiplied �
Transformers/Power Su lies $5 Each by the number of required inspection trips, ���.�. _
whichever is greater)
Requests for Electrical Inspectfon (REI) with a fee of $250 or less expire 12 months from the ftltng date. The contractor/employer must have the work
completed within the 12 month period or submit another REI that includes the inspection fee for the uncompleted work. Inspectfon fees do not carry over
s� �3a - d'� 6� 3 0-o fj from one REI to another.
A service char e of $30 will be added for all dlshonored checks.
I hereby certify that I inspected the electriql installa6on herein on the dates stated: For Department Use Only
Rough — In Inspection(s) �, z �ateo �
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Final Inspection/�' Date
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i nis matenai can ue maae avauauie m dmerent forms, sucn as large print, Braille or on a tape. To request, call
TDD (651) 297-4198.
REI 03 (6/07) %� 6 }'� C�� �
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