P - 75586Minnesota Dep�itment of Labor and Industry
443 Lafayette oad North
St. Paul, MN ,�5155-4342
Phone: (651 284-5064
TTY/MRS: 1) 297-4198
www.electri .state.mn.us
Contractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
08/05/2008 Contractor Must Schedule All Rou h-In
Address of Inspection — Street
4571 2 1/2 STREET NE
MICHA THOMAS
(763) 502-0775
CENTERPOINT ENERGY
Contractor Telephone Number
(763) 757-6202
tion — One Famil � Dwellin /Assc
Yes Single Inspection Other Than Rough-In:
Contractor Must
City/Township County
FRIDLEY ANOKA
Project Description
WIRE/ RECONNECT FURNACE AND AIR
CONDITIONER
Structure
] Ready Now
l Will schedule
convactor mamng address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS. MN 55433
Contractor License Number
CA01796
Fee Calculation
or Associated Structure
New Dwelling Service/Power Supply 0— c�{�e @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
Nuw Ilu�ollinn Fcn.iorc/Cir.h�G*e
— More
Other (Specify)
) Feeders/Circuits - $100
cuits (in addition to
To 200 A (a� $6 Each
Detached Garage or Other Associated Structure
New Servic�/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
JOANN ZINKEN
Existing Home/Structure Remodel or Addition
New Service/Power Supply
New Service/Power Supply
0 — 400 ampere @ $35
401— 800 ampere @ $60
— Up to 15 Feeders/Circuits
�6 Each or 16 to 30 $100
— More Than 30 FeederslCircu
ts Up to 200 A[a� $6 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 (Soecifiil
$4
i oiai �tne tee caiculatetl above or $35 multiplied Total (the fee calculated above or $35 multiplied v
by the number of required inspection trips, by the number of required inspection trips, 3S, S
whichever is greater) whichever is greater)
Requests for Electrlcal InspecUon (REI) wlth a fee of $250 or less expire 12 months from the flling da4e. The corrtractor must have the work completed within
the 12 month perlod or submit another REI that includes the InspecUon fee for the uncompleted work. Inspection fees do not carry over from one REI to
another. •
A servlce charge of $30 will be added for all dtshonored checks.
I hereby certity that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date .
����e �nawn oe maae a+vanaoie In altte�eltt tOrrtls, suCh eS
TDD (651) 7•4198.
REI 02 (6/0�
� ��� -� l�`��
RECD AUG 0 7 2008
or on a tape. To request, call 1-800-342-53;
or