P - 76234Minnesota D artment of Labor and Industry
443 Lafaye Road North
St. Paul, M 55155-4342
Phone: (6 ) 284-5064
TTY/MRS� 651) 297-4198
www.ele ity.state.mn.us
Contractor Re uest for Electrical I
Da Rough-In Inspection Required?
/� � Contractor Must Schedule All Rou I
A�i P Insoe n— Str et
lQ� _ �1 Yt�-��Q�Q S�- •
? �d5� — .�.�rv
Name
� o� �'� �fir ��-
�
�
�DC�� Ol,���
REC'D J U L 18 2001
s ection — One Famil Dwellin /Asso
❑ Yes Single Inspection Other Than Rough-In:
n I`n ections Contractor Must Schedule All Final Ins e
City/Tgwnship ,_ County
Project Dascripti n s
� l� °�I�.�%�'l��' ���%-�
�
Contractor M'ling ifV s�d�1 I
Contractor E-mail Address
Fee Calculation
New Home or Associated Structure
New Dwefling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Dwelling Feeders/Circuits � �i��
Up to 30 Feeders/Circuits - $100
Idew Home — More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A@$6 Each
Other (Specify)
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits
Other (Specify)
Other (Specify)
( ) @ $6 Each
� �— ,��
tructure
Ready Now
Will Schedule
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
New/Extended Feeders�/Circuif§ — Up to 15 FeederslCircuits �
Feeders/Circuits $6 Each or 16 to 30 $100
Ne /Extended Feeders/Circuits — More Than 30 Feeders/Circuits
Feeders/Circuits U to 200 A $6 Each
Reconnected Feeders/Circuits
Feeders/Circuits $2 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Specify)
,�
�
�
TOtal (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, C
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from thefiling date. Tha contractor.must have the work completed within
the 12 month per(od or submit another REI that includes the inspectfon fee for the uncompleted work. lnspection fees do not carry over from one.REl to
another.
A service charge of $30 will be added for all dishonored checks.
I hereby certify that f inspected the electrical installaGon herein on the dates stated: For Department Use Only
Rough — In� Inspection(s) Date
Final Inspection
Thts material can bi
TDD (651) 29T-4198.
REI 02 (6/07)
� � ��
such as large prtnt, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Volce or