The URL can be used to link to this page

P - 75466, . . •' '�.��' t� �$a �.t°`;, �" , j ^ 1°� °� � � ��:� t . � �,,,,.._. Mmnesota Depa t of Labor and Industry ''�`+�f �� ° l ��` �� -�' 443 Lafayette Ro � North St. Paul, PAN a5 5-4342 Rhone: (65i) 2 5064 Tl'Y/MRS: (6 287-4188 www.elecfici state.mn.us ��n�r� r R� ca��t �or �I��trical [rn� ��i�n � �n� Farnii �w�Nin /�issocia��d �tructur� �at Ftough-tn Inspection Requir�cl7 Y�s 5�� rtsPection �ther ihan Rough-tn: Ready I�oav � s? °C�' CoMractar Must Schadule Ap Rou h-In Ins ections Contrac4or Must Schedule Afl Final Ins ections , Will Sctledul� Ad tns on - Sfreet -� City�shlg Courrty �� ..� ��.-`,��, , �'/'.:;�' � = � �:',.�' ,��-�-- Owr►ecaiVame , Projed Descrip on ` c'�,� , t� , � �1 � s!"'�,. -- � s-�1.,�,E,� :�:.�._ � C - _ � �� d.., ` �i - /�`j`� �_ - .. Owner Telephone umber{s) - tnolude Area Codets) ,�� '°'��° � =� � ,»�.-` ,�y _ �'`�� `� ��.,��'��`�''�' ��'-�.l`�I;i,I��T��' l,�r�..r� Contr�actor Name . � �Cor►tractor AAailing Address . �'�.,�r'��% J�� A�. _ �� a:� j�'`° ; � �",� f' '�" ,��' � s'°"td'ti .��"'C. �L= .�:.rl ' � �� e=' �,g° Contractor l'elephone Number Contractor E-mail Address Electrical Utility , , . �, ��,, , '�. i �� .� �.� �,r., _��Go ` tor Author�ce Sigr�#uce _ Contracto� License Number Job/Praiect Contact Per�bn �' ' �:� ' __.. . ��-' ��,�,-�t�i %�� •-:.�' . �.�° �� SC�la�4i�� Wew Home or Assacts4ed �tructure Eaci��ing MornelStructure Rer�►odel t�r Ad�ition New Dwelling Servtce/Power Suppfy 0- 400 ar►�Sere @$35 Mew Service/Pawer Supply 0- 4� ampere �$35 �� New Dwelling ServicelPower Supply 401- 800 ampsre �$60 New Serviceif'ower Supply 4�9 -- �00 am�oere @$6D New Dwelling F�aders/Clrcuits New Feaders/CUcufts -- Up to 15 Feeders/Ckcuits u ta 3a Feedersrc�cu�ts -$90o Feeders�cir�,ns �a Eec,� ar �s co 30 $+100 �� Neav Home - More than 30 �eederslCireuits (in addition to New aedsrs/Circuits - More Than 30 Feeders/Circuits above Feeders/Clrcuits tf To 200 A $6 Each FeederslCUcufts U to 200 A $B �ach Other (Spectfy) Reconnected FeederslCfrcutts Faeders/Circuits $2 Each Detached Parage or �h�r A�octaY�d :5truciur� DeEach�d C�se�ge ar IDther A�soclated S#ructur� Plew ServlcelPower 3upply 0� 400 ampere �$35 New Senrica/Power Supply 0- 400 ampere @ S35 New Feed�rs/Clrcults ( ) � $6 Each IVew FeederslCircuits ( ) (� $6 Each Other (Specify) Reconnested FeederslGircuits ( ) � $2 Eackt Other (Specify) Other iSP�Y) TOtaf (the fee c�iculated above or �;35 muttiplied io�al (the fee calculated above or $35 multipi3ed __b�the number of r ui J in�cd�n3rips. __— ---- - mber�f reqatred-inspection trips; � r,� ��`� " uvhichever is greater) arhfcheve� ts greater) Requests for Eletteicai Inepectlon �RE() rtlfh a fes ot $280 or tess e�Fre 92 mor►tNs ftom the tlling date. Fhe corrtractor must heve the mro►k compteted wtthln the 72 month periad or submit arrother �Ei 4hat Includes the Mspecttan fes torthe uncompleted werk. lnspection fees do noi carry over feom one REi to enother. A serviee charge of S30 wiN be added for aU diallonored checka. ' r r,e�y �rtuy tn�c i a,s�«$a n,� er�i u,st�ae�, n�u, rn, n,e a� �ea: C�� °� t Q,� � Rough - In Inspection(s) Date �, . , i �( Inspection Dete �� S E� Z Q �000 ��"' � - z�� eJ p �G `t'hia mateNai can be made aaailebte In dtfferent form�, such ee farge p►Int, �rallls or on a tape. �'o request, call 9-800-342-6354 (DIAL-DU} Vpic� or S9D (881j E6T-4188. i2El 02 (6/07) - — � . /