P - 76665Minnesota D artment of Labor and Industry
443 Lafaye Road North
St. Paul, 55155-4342
Phone: 1) 284-5064
TTY/M : (651) 297-4198
www.el ricity.state.mn.us
Contractor/Re istereci Em
Date Rough-In Inspection Required?
G��V �� ContractorlEm lo er Must Schedule All Rou h-Ir
Yes
Address of Inspectio Street
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Owner Telephone Number(s) — clude Area Code(s)
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RECD OCT 2 9 2007
te uest for Electrical Ins ection
Single Inspection Other Than Rough-In: � Ready Now
ContractoNEm lo er Must Schedule All Final Ins ections ❑ Will Schedule
:ity/T nsh' Coun
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roject Descripti
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Contractor/Registered Emp yer Name Contractor/Registered Employer Mail
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Contractor/Employer Telephone Number ontractor/Employer E-mail Address
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Co ctor/EmployerAuth ized Signa re Contractor License Number
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Fee Calculation
Service/Power Supply `�'�i 0— 400 ampere @$35 �
Service/Power Supply
Service/Power Supply
401 — 800 ampere @ $60
Above 800 ampere @ a100
New/Extended Feeders/Circuits Up To 200 A( �—j-� $6 Each
Feeders/Circuits Above 200 A ( )@$15 Each
Reconnected Feeders/Circuits ( � �- ) @ $2 Each
Manufactured Home Park Lot Supply ( )@$35 Each
Recreational Vehicle Site Supply Equipment
( ) Circuits Originating in the Equipment @$6 Each
Street, Parking Lot, Lighting Standard ( )@$5 Each
Transformers Up to 10 kva ( )@$15 Each
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Electrical Utility
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Technology System Devices (
Separate Bonding Inspections for
Equipotential Planes (
Center Pivot Irrigation Booms (
Plus Electrical
— - -- --� -----
Luminaire Retrofit Modifications (
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Person
) @ 75¢ Each
�ing Pools and
) @ $35 Each
) @ $35 Each
Units $5 Each
) @ 25¢ Each
Concrete-Encased Electrode Inspection ( ) @ $35 Each
Investigative Fee $70 Or The Total Inspection Fee,
Whichever Is Greater Up To $1,000
Special Inspection Fee ( ) Hours @$80 Per Hour
Plus ( ) Miles @ The IRS Mileaqe Rate of (
Other
�V2f 6�0 �/O�tS — Add the wmbined service/power supply and feeder/circuit fee to
result in double the regular fee (does not apply ro electnc sign and outline lighting)
( ) New PAulti-Family Dwellings @ $70 Each
With Up To 20 Feeders/Circuits
Transformers Over 10 kva ( )@$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
$6 Each
Electric Signs and Outline Lighting TOt81 (the fee calculated above or $35 multiplied
Transformers/Power Su lies $5 Each by the number of required inspection trips,
whichever is greater)
Requests for Electrical Inspection (REI) with a fee of $?.50 or less expire 12 months from the filing date. The contrector/employer must have t e 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 one REI to another.
A service char e 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
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Inspection
This material can be made available in different forms, such as large
TDD (651) 297�198.
REI 03 (6/07)
or on a tape. To request,
(DIAL-DL1) Voice or