2018-00035 ELEC SERVICES, NEW�� ��� n �o��
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` MFIN[��SOTR 1��PARTMElY7' CF�
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443 Lafayetie Roed North
St� Paul, MN 55755�4342
Phone; (659j 264-502fi
www.dll.mn.gov
For Offiee Use
Amount
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Req�uest for Electrical Inspectian (REl) (permit)
Non-Dwell�ngs and Multi-Famity Dwellings
Fields marked with an ast,erisk'" are required (as appl9cable).
Incomplete, in�ccurafie, or ill�gible f�rms may be returned to the submitt�r,
* Check One:
Y'S DAT�
Cqntractor �r ❑ Reqistered Employer '' CheCk dne Box: ❑ New Bldg ar ��xistin8 Bkdg
` Check One BOX� ❑ Multi-Famlly Dwelling or ❑ Non-Dwel{Ing {all proJeats other than dwellings)
• Permit Sub-Type { ck one box)
❑ Agricultural CommercIal ❑ Qavernment ❑ IndusWal ❑ Instltutlanat ❑ Reareational ❑ 7schnology
* Pr.oJect LqeaE9�n (number & street na e} * Project County,
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' Ptdject Tt�VVn�iilp:' (Please e eronly'the nshl nam � P� �ct Cit : " Projec Z[�
.._ a e� am not bdth) " �„
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� Owner Name — . � " Owner �hone Owner Cel1 awner EM1 t` �I� � . . - - . - -
r�t
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one �ox
' Tech,na�ogy.System COntractor
istration No. .'C�ompeny iValt�e � ti 1
❑ Regist�red Employer
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❑ .Class S Instalfer
*
'' Carn pany Ad�tr�ss. � yr!�y . "' .
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*�ampany P�one . Company Cell ' Company E-m�il �ontact Pe p�a�
��. 1�!�t� � � : �� C�1�(�C G� tc
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N
Sin Inspectfan �
* Project Daseription (Scope of work, $ervice size, quarrtity of Raugh-in Inspection
feeders and circuits, job numb�rs, ar other vital information to �er than Rough-in? Required?
help the electrical inspector make timel inspection service) Rsady Now or es or ❑ No
Wil1 Schsdule
�����'�(� �� ` � � ��,� Oirections to Project Sita
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���'�� �–�,�C �,�,), ��� Proje�t Slte (Contact Person and Phone}
Electrical Ublity
TOTAL INSP�CTIaN PEE frorn REI fee workshee� or $35 multiplied Ent�r Inspection Fee Here» � ���jbp
b#he number of re uired ins e�tlon tri s whlchever is reater.
A surcharge af $1 is imposed on every permit effective 7Y1I15 Surcha�ge Fee �y $ 1.00
as er M.�. 926B.148 in addition to the 1ns ection fee.
� , * Grand Total� (Inspection Fee plus Surchawge .Fee) * l�.n ��
ROpuestafor Electricil Irtfptctlon {I2EI} wlth a fea of $280 ar le9s explra t2 moMNs n'om the flling date. ili¢ ��g�s��er must hOvOthewo�k compl6fi0q �+R1�In tha i2 morrth
perqcf orsubmR anothar REI tBat ���uaes the fnspection ke ror the uncomptatsd woYk- l�pectlon fees do „ot carry ovar frorrl d� explred REI ta a new RE�•
p 9ervlce char e oFE90 w1�1 be edded for all dishonared checks
7hla meterial cao be made avaiiable in diiferentivrms, su� es lerge prirA, Bieillo or on s tape. To request, taV 7-Soo-3d2-5354 (DIAL,•OLq Volce or TDD (861) 297d19$.
1�lease submit REI fdrms together with the appllcable fees to:
City of Fridley, 6431 University Avenue N�, Fridley, MN 55432
REI 16 (10115} RE1_18_MultiFamllyAndflonDwellings (I�evised 10l13/115}
Request �or �lectrical
1 MINN�S01y�IS�pA1�7'MENTO� `�Spec�ion (REI) (permi�)
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L,AB01� 8C 1NDLYSYRY
443 Lafayette Road North
St.PauI,MN 55155�342 �rj$ ec#iQn Fee Workshee�
Phone: �661) 2$4-5026 �
www.dli.mn.gov
Item Description f�uantity Fee Total
0 to 400 Amp Power 5ource � 3513ource �
401 - 8fl0 Amp Pawer Spurce $ 60/source
Qver 800 Amp Power Source � 100lsaurce
0 to 200 Amp Circuit or Feeder $ 6/feeder or circuit i�(� �
Over 200 Amp Gircuit or Feeder $ 15lfeeder o� circuit
:._-s.;�,�
�� 0 to A00 Amp Power Saurce 70lsource
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`.Q'.; �101 - B00 Amp Power Source $ 12p/source
>7<;:
`.` �y� Over 800 Amp I'awer Source $ 200lsource
. ��
! �':�'�; 12/feeder or circuit
�;; p to 2Q0 Amp Circuit or Feeder $
O:
�:;: Over ZOQ Amp Circuit or Feeder $ 34lfeeder or circuit
New Multi-Family Dwelling Unit $ �Q��n�t
with u to 20 circuits and feeders er unit
New Multi-Family Dwefiing. Unit $ 6lfeeder or circuit
�dditiortal circuits over 20 er unit
Existing Multi-Fami{y Dwelling Unit $ 70lunit
where 1 D or m�re feeders or circuits are instalied or extanded
Existing MuEti-Family Dwelling Unit g 6lfeeder or circuit
where less thar► 14 feeders or circuits are installed or eactended
Reconnected Existing Circuit or Feeder (for panelboard replacements) $ 2/feeder or circuit
Ttansformer (Light, Heat or Power) rated up to 1 pKVA $ 15/transformer
iransfarmer (Lfght, Heat or Power) rated in axcess of 10iNA $ 30/transformer
Manuf�c#ured Home Park (Lot Supply) $ 35/pedestal
RV Pedeslals (all circuits originating in pedestal incl. factory circuits) � 6lcircuit
Street, Parking Lot, butdoor, Traffic 5t2ndards � 5/standard
Power Supplies fot Signs & �utline Lighting $ 5lpower supply
Technology circults & circuit5 less than 50 volts 75¢Idevice or apparatus
Retroflt of existing lighting fixtures 25¢lfixture
Additional inspection trip{s) $ 35/inspection trip
Investi.gative Fee (enfer values in the Qu�ntity and Fee columns)
Other... �
TOTAL (NSP�C7IQN FE� is the fee calcufat�d above, ��ab
or $35 mulitplied by the number af r�qulred inspection trips, whlchaver is greater.
Er�ter fns �ctlon Fee Here & on REI »
REl 16 (10115) REI_1B�,Muttl�amllyAndNonDwellings (Revised 10l13I/15�