P - 76815Minnesota Department of Labor and Industry
443 Lafayette R d North
St. Paul, MN 55-4342
Phone: (651 84-5064
TTY/MRS: 51) 297-4198
www.elect ity.state.mn.us
Cont ctor Re uest for Electrical Ins ection - One Famil Dweilin /Associated S ucture
Date Rough-In Inspection Required? ❑ Yes Single Inspection Other Than Rough-In: Ready Now
�(i� Contractor Must Schedule All Rou h-In Ins ections Contractor Must Schedule All Final Insaections I n Will Schedule
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ractor Name �
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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 Dwelling
New Home — More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A@$6 Each
Other (Specify)
Detached Garage or Other Associated Structure
New Senrice/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other
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Electrical Utility '
Job/Project Cor}tac�'I�erson �
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
New/ xtended FeederslCircuits — Up to 15 Feeders/Circuits
( ) Feeders/Circuits @$6 Each or 16 to 30 @$100
New xtended Feeders/Circuits — More Than 30 Feeders/Circui
( 1 Feeders/Circuits Up to 200 A(a� $6 Each
( ) 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
Other (Specify)
/V
Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, �'�j�
whichever is greater) whichever is greater) `�`�
Requests for Electrical Inspection (REI) with a fee of $250 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 one 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
F�(al Inspection
This material can be made
TDD (651) 297-4198.
REI 02 (6/07)
Date
�o-9-C7
such as large print, Braille or on a tape. To request, Call 1-H00-34Z-5354 (UTAL-ULI) VOICe O�