P - 75157Minnesota Dep�, nt of I.ahor and Induslry
� 443 Lafayette d North
St. Paul, MN � 155-43A2 � �,�� �
Phone: (65 284-5084 .
1'TY/MRS' 651) 297-4198 '
uwuw.ele c�ty.state.mn.us
Contractor/Re istered Em lo er Re uest for Electrical Ins ectlon
�� Rough-In Inspection Required? Yes Single irre�dion Other Then Rough-In: Ready Now
3' � Z` o� ContractodEm 1 er AAust Schedule Ap Rou h-In Ins ons ContractodEm lo Must Schedule All Finel Ins ons dNiU Schedule
Address of Inspectlon — Street CitylTownship County
�� 3 0 �� d e. S N E �i� ��1�� /-��►� �
Owner Name Project DescripUon •
I e IV O lr(Nlo� vu E� ZL�I C°i� �l� '�v�'�i�Ct � �` G
Owner Telephone Number(s) — Inciude Area Code(s)
� . �,c) s' .`i 5 �'e�lq ce ��, �-�
Contrector/Registered Employer ldame CantractoNReglatered Employer Mailing Address
SUBURBAN ELECTRIC, INC. 14800 28TH AVE N, SUITE 125, PLYMOUTH, MN 55447
Contractor/Empfoyer Telephone Numbe� ContradoNEmployer E-meil Address Electrical Utllity '
763-498-7215 '
Contrector ployer �wthorized Signature Cantractor License Number Job/Projed Contact Person
wt
� - ' �-- CA02503
�
. � � Fee Calculation
Service/Power Supply 0— 400 ampere �$35 Technol�y System Devices ( )� 75¢ Each
Servlce/Paarer Suppty 401 — 800 ampere �$8U ���� �nding Inspecdons for Swimming Pools and .
E ui tentlal Planes $35 Each
Servtce/Power Supply Above 800 ampere �$100 � Center Pivot irrigatlon Boams ( )�$J5 Each
Pius Electrical Qrive Uuit4 @$5 Each
New/Extended Feeders/Circut� Up To 200 A( ) cLiD $6 Each Luminaire Retroflt Modiflcetlons ( ) Q 25¢ Eech
Feeders/Ctrcuits Above 200 A ( )�$15 Each Concrete-Encased Electrode lnspection ( )@$35 Each
Reconnected Feeder�Circuits ( �,� $2 �� InvesUgative Fee $70 Or The Total InspecHon Fee,
Whichever Is Greater U To $9,000
Manufactured Home Park Lot Supply ( )�$35 Each Special Inspedlon Fee ( ) Haurs (a� $80 Per Hour
Plus Mlles The IRS Mpe e Rete of
Recreatlonal Vehlde SRe Supply Equipment Other
Circutffi Ori ineti in �e E ui ment $6 Each
Street, Parlcing Lot, Ugfitlng Standard ( )(a� $5 Each Over 600 Votts — nad ��or�nrea �o��r �,rWy �na r�nm�c r« m
�a � em,vte we r�d� ree �does �c ��y w�e�� �an ana a,wre ne�e)
Transformers Up to.10 kva ( )@$15 Each � ) New Muld-Femily Dwellings @$70 Each
1Nf� Up To ZO Fe�erslCircuits
Transformers Over 10 kva ( )@f $30 Each ( ) Additlonal CUcuits Above The 20 Allow�f Per Unft
6 Each
ElecMc Signs and Outline UghUrtg TOtel (the fee catcul�ted above or $35 multipUed
TransPormere/Power Su Ile.s $5 Each by the numtrer�of required tnspecdan trips, 3� ,,�
whichever is greaterj
Requests for ElecMcal UispeWon (REI).w(th a tee of $260 or lese explre 12 months irom the flBng daba. The aor�todemployer must have the work
completed wlthln H�e 12 month perlod or submit enother REI tl�at Includee the Mspeodon fee for fhe unaompleted atork. I��on fees do not cazry+ over
fram o�re REI to another.
A servl� ah e of $30 wip 1� added tor atl dishonered cheaks.
I hereby cerNijr thet I fnspected the electriaal ins�llatlon hereM on the datea atated: For De�rtmeM Uae Only
Rough — In Inspectlon(s) Date �
� C��� � `�j�
Finai Inspectfon ��at�e a p[� � Q�'1 4�oa�
J 1�
This materlal can e avallable in dlttereM� torma, such qs large prirM, Brellle o� on a tape. To requast, ce�� 1-800 342-5354 (GIAI--�UI Volce or
TDD (8S1) 297-4188.
REI 03 (8/07)