P - 75635Minnesota De
443 Lafayette
St. Paul, MN
Phone: (65 ,
TTY/MRS:
vwvw.elec it
�nt of Labor and Industry
NoRh ' '
)297-4198
ctor Re uest for Electrical Ins ection — One Famil Dwelli�
� Rough-In Inspection Required? Yes Single Inspection Other Than
Contractor Must Schedule All Rou h-In Ins ections Contractor Must Schedule All
_spection — Street City/Township
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Telephone Number(s) —
Name
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tl S�gnature
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Code(s)
Contractor M�
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Contractor License Number
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Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Dwellmg Feeders/Circuits
Up to 30 Feeders/Circuits -
— More than 30 Feeders/Circuits (in addition to
To 200 A
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New FeedersJCircuits ( ) @ $6 Each
Other (Saecifvl
Nssvc�a�e -tructure
�gh-In: Ready Now
al Inspections ❑ Will Schedule
Counry
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Existing Home/Structure Remodel or Addition
New Service/Power Supply
New Service/Power Supply
0 — 400 ampere @ $35
401 — 800 ampere @ $60
ts — Up to 15 Feeders/Circuits
$6 Each or 16 to 30 $100
— Mnro Th�n �n F�,�o.�ir��.„.a
to Z00 A
( ) 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
Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the num6er of required inspection trips, by the number of required inspection trips,
whichever is greater) whichever is greater)
Requests for Etectrical Inspection (REI) with a fee of a250 or less explre 12 months from t filing date. The contractor must have the work com{ileted within
the 12 month period or submit another REI that I�cludes the inspection fee for the un mpleted work. Inspectfon fees do not carry over from one REI to
another.
A service charge of $30 will be added f all dishonored checks.
I hereby certify that I inspected the electrical installation herein o� the dates stated: For Departme�t Use Only
Rough — In Inspection(s) Date. �G
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Final Inspection� �— �� t� � ��p J U L 2''� Z00e
This matenal can be made available In
TDD (651) 297-4196.
REI 02 (6/07)
sucn as large print, Braille or on a tape. To
or
.