P - 75551Min�eso4a De
443 Lafayette
St Paul, MN
Ph�ne: (651)
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Name
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nt of Labor and Industry
d N�rth
ss-4342
1)297-4196 ,
.stafe.mn.us
Homeowner Re
Rough-In Inspedion Required?
Homeowner Must Schedule All Rough-
�ction — Street _
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Ov�mer Mailing Addres:
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RESIDENTIAL ELECTRICAL PERMR BY HOMEOWNER
PERMIT # �
RECENED: �
uest for Electricat Ins ectib�n
� y� Inspecti�n OtfierThan Rough-�n: ❑ Ready Novd
Ins 'ons Homeawner Must Schedule Ail Fnal ins 'ons ❑ lIViA 5chedule
Citylf�vunship County
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Projed Q�scription ,
a�� c�r� �-�-v� � � fo�l '�
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State Trp Code
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O�wner E-mail Addr�ss .�—�.� --..., J ��
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By signirtg this dacument, I c�rtify ihat I am the ovmer as defined by Minn. Stat § 326.01 and wnll legally pertorm tfie e 'cal vroric
Ownar Signature '
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Fee Calculation
New Home or Associated Struciure
New Home Servic�JPawer Supply 0— 4d0 ampe2 @$35
New Home "' ' h' �� --E��P$� S50 -
Up to 30 Feeders/Circa�its -
— More than 3D FeedersJCircuits (in add'dion to
1 Feeders/Circuits U� To 200 A(a� $6 Each
Detached Garage or Other Associated Structure
New Service/Power Suppfy
New Feeders/Circuits
Other (Speciiv?
0 — 400 ampere @ $35
( ) @ �6 Each
Existing HomelStructure Remodel or Addition
New SenricelPawer Supply 0— 400 ampere �$35
Nevv Saruical��nrer SuPPI� 49-4 —�09-at��e-G-$60
FeederslCircuits — Up to 15
} Feeder�CircuNs @ $�
FeederslCircUits - More Th
( 1 Feeders/Circuits
Each or 16 to 30 h� 5100
Detached Garage or Other Associated Sfiructure
New 5ervic�e/Power Supply
New Feeders/Circuits
Reconnected Feeders/Circuits
0 — 400 ampere @ $35
( ) @ $6 Each
( ) @ $2 Each
Other (Spec�fy) �cner (sPecrt�') • o 0
a, � ,r�u��Q �'o a � me�r,3 S.
To�'dl (the fee cakailated above or $35 multiplied Total (the fee cala�lated above or $35 multiplied
by the number of required inspectlon trips, , by the number of required inspection trips,
whichever is greafer) whicheder is greater) �
Requests for Electrical lnspection (REI) wrth a f� of $ZSO or less ezpire 12 mertidis from the filing date. The owner must have the work comple within the
12 morrth pe�iod or submk another REI that includes the inspeetlon fee for the uncompleted work. InspecUon fees do not carty over from on I to another.
A service e of $30 wfll ba added for aIl dishonered ch2cks.
I hereby certify that I fnspeded the el�trical instaliafron herein on fhe dates �ated: �_ ^F��ent Us� Onfy
Rough — In Inspection{s) ' Date �� � � �
�,p �) c�
Final Inspection � Date • �� � � � �' � 200
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This material can bi
TDD (651) 297-4138.
REI 01 (6I0�
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available in different forms, such as large print, Brallle or on a tape, To request,
Voice or
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