P - 76672Minnesota Department of Labor and Industry
443 Lafayette ad North
St. Paul, MN 155-4342
Phone: (65 284-5064
TTY/MRS' 651) 297-4198
www.ele icity.state.mn.us
Con actor Re uest for Electrical Ins
Date Rough-In Inspection Required?
� ��� Contractor Must Schedule All Rou h-In
ddr ss o In ection — S eet
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Owner Telephone Number(s) — Incl e Area Code(s)
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Contra Name � Contractor Mailing
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Contrac r Teleohone �lumber Contractor
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�cro o c T i 2 2001
tion — One Famil Dwellin /Associated ructure
Yes Single Inspection Other Than Rough-In: Ready Now
�ctions Contractor Must Schedule Atl Final Ins ections ❑ Will Schedule
City/Towpship , „ County , l
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New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
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�roject Oescri tion
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Address
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Fee Calculation
New Dwelling Service/Power Supply 401 — 800 ampere @$60
Up to 30 FeederslCircuits - $1
New Home — More than 30 Feeders/Circuits (in addition to
above) ( ) FeederslCircuits Up To 200 A@$6 Each
Other (Specify)
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits
Other (Specify)
Other
( ) @ $6 Each
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Electrical Utilitv
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
New/ xtended Feeders/Circuits — Up to 15 Feeders/Circuits
Feeders/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
:
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 Electrical Inspection (REI) with a fee of a250 or less expire 12 months from the filing date. The contractor must have the work completed within
the 12 month period or submit another REI that includes the inspection fee for the uncompleted work. Inspection fees do not carry over from o�e REI to
another.
A service charge of $30 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
Fi�al Inspection Date
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This material can be made available in different forms, such as large print, Braille or on a tape. To request, Cell 7-500-34Z-5354 (UTAL-Ul.l) VOIC6 Of
TDD (651) 297-4198.
REI 02 (6/07)