P - 75566Minnesota Depa nt of Labor and Industry
443 Lafayette cl North
St. Paul, MN 155-4342
Phone: (65 84-5064
TTY/MRS: 51) 297-4198
www.ele city.state.mn.us
Contractor/Re istered Em
Date Rough-In InspecUon Required?
4/1 /08 �ntractorlEm lo er Must Schedule AII Rou h-Ir
Address of Inspection — Street
5830ND STREET NE G���� ,`� �`� � r(i
Owner Name
VIOLET WOODS
Owner Telephone Number(s) — Include Area Code(s)
(763) 780-7199
Contractor/Registered Employer Name
SCHMIDT ELECTRIC INC
Contractor/Employer Telephone Number
(952) 472-8643
Yes
a�� �03� �
'{ �) A�� � ��i
uest for Electrical Ins
FRIDLEY
REPLACE BOILER
"'• U Ready Now
UI Final Ins�c�ions Q Will Schedule
County
ANOKA
ContractoNRegistered Employer Mailing Address
6480 SOUTH SAUNDERS LAKE DR, MINNETRISTA, MN 55364
Contractor/Employer E-mail Address Electrical Utility
mark@schmidtelectricinc.com
Contractor License Number Job/Project Contact Person
C',�/���� ,�(��`- � CA04526 I � ��
Fee Calculation
Service/Power Supply 0— 400 ampere @$35 Technology System Devices (
Separate Bonding Inspections for Swimrr
Servic�lPower Supply 401 — 800 ampere @$60
E ui otential Planes
Service/Power Supply Above 800 ampere @$100
Center Pivot Irrigation Booms (
- - ---- Plus Eledrical D:'r✓R
New/Extended Feeders/Circuits Up To 200 A( )@$6 Each Luminaire Retrofit Modfications (
Feeders/Circuits Above 200 A ( )@$15 Each Concrete-Encased Electrode Inspection (
Reconnected FeedersJCircuits ( )@$2 Each Investigative Fee $70 Or The Total Inspe�
Whichever Is Greater U To $1,000
Manufactured Home Park Lot Su I Special Inspection Fee ( ) Hours
pp y ( ) @ $35 Each
Plus ( ) Miles Caa The IRS Mil�
) @ 75¢ Each
ig Pools and
) � $35 Each
) @ $35 Each
) @ 25¢ Each
) @ $35 Each
�0 Per Hour
Rate of (
Circuits Ori inatin in the E ui ment $6 Each
Street, Parking Lot, Lighting Standard ( )@$5 Each �e� 6OO VOItS — Atltl the comb(ned sarvicelpower supply and feeder/arcuft tee to
resutt in double the repularfee (does rrot apply to electric slgn and outllne lighdng)
Transformers Up to 10 kva ( )@$15 Each � ) New Multi-Family Dwellings �$70 Each
Wdh Up To 20 Feeders/Circui�
Transformers Over 10 kva ( )@$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
6 Each
Eledric Signs and OuUine Lighting TOtal (the fee plculated above or $35 multiplied
Transformers/Power Su lies $5 Each by the number of required inspedion trips,
whichever is greater) $35.50
Requests for Electrlcal InspectJon (REq wlth a fee of $250 or I�s explre 12 mo from the flling date. The contractorlemployer must have the work
completed wlthln the 12 morrth perlod or submk another REI that Includes the Ins on fee for the uncompleted work. Inspe�tlon fees do not carry over
ev�9 �_ a� �� from one REI nother.
A servlce ch e of $30 wlll be a ed for all dlshonored checks.
I hereby certify that I inspecded the ele.ctrical installation herein on he dates stated: For Deparfi'�ent Use Only
Rough — In Inspection(s) Date
_ < _-�-'� �~ ��� �
Thls materlal can made avallable in dlfferent forms, such as large print, Brallle or on a tape. To requ�t, call 1-800-342-6364 (DIAL-DLI) Volce or
TDD (651) 297-4198.
REI 03 (6/07)