P - 76684Minnesota Department of labor and Industry ��j� !���Gf �
443 Lafayett �'Road North �r�� � � � �'7 ADO�
St. Peul, M- 55155-4342 IiC L
Phone: (6 ) 284-5064
TTY/MRS (651) 297-4198
www.ele 'city.state.mn.us
Cont ctor Re uest for Electrical Ins ection — One Famil Dwellin /Associated tructure
Date Rough-In Inspection Required? Yes Single Inspection Other Than Rough-In: ady Now
U"�� Contractor Must Schedule All Rouqh_In Insnections Contractor Must Schedule All Final Insaections ❑ Will Schedule
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Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0-400 ampere @$35
New Dweiling Service/Power Supply 401 — 800 ampere @$60
New Dwelling Feeders/Circuits
Up to 30 Feeders/Circuits - $1
— Mare than 30 Feeders/Circuits (in addition to
) Feeders/Circuits Up To 200 A@$6 Each
Detached Garaae or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
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Job/Project�'(J
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
New/ tended Feeders/Circuits — Up to 15 Feeders/Circuits
eeders/Circuits $6 Each or 16 to 30 $100
New/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 (S�ecifv)
TOtal (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied C
by the nc�m6er of required inspeetion trips, by the number of required inspection trips,
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REIi with a fee of 5250 or less expire 12 months from the filing date. The contractor must have the work completed withi�
the 12 month period or submit another REI that includes the inspection fee for the uncompleted work. Inspection fees do not carry over f�om one REI to
another.
A service charge of E30 will be added for all dishonored checks.
I hereby certify that I inspected
Rough — In Inspection(s)
Final Inspection
This material can bi
TDD (651) 297-4198.
REI 02 (6/07)
on tne dates statea:
Date
,� Date
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