P - 75305Minnesota D rtment of Labor and Industry
443 Lafaye f2oad IVorth
St. Paul, M 55155-4342
Phone: ( � 2845064
TTY/MR (651) 297-4198
Co ctor Re uest for Electrical In
�� Rough-In Inspection Required?
2-18-08 Contractor Must Schedule All Rou h-I
Address of Inspecc�on - Street
5980 2ND ST'!� �.IE AP� ��.+-
Ovmer Name
VITALY CHERNIKH
Owmer Telephone Number(s) - Include Area Code(s)
(763) 227-8237
�o�tv-� C�d�Srh -�^S'�
l051- 777- 7Fre'S
tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: Q Ready Now
icUons Contrac9:or Must Schedule All Final Irts 'ons Will Schedule
City/Township County
FRIDLEY HENNIPEN
REPLACE OUTLET AND FUSE PER FIRE MARSHALL
I3elo� � -
Contractor Name Contractor Mailing Address
ANGEL ELECTRIC INC 900 73RD WAY N, BROOKLYN PARK, MN 55444
Co�actor Telephone Number Contractor E-mail Address Electrical Utilityr
503-6737
�r Authori�
�
CoMractor License Number Job/Project Contact Person
CA034�- - -- — - -- - CARtBQft�- — -- - - — - --- �
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
Ne�a Dwelling Servi�/Power Supply 0- 400 ampere @$35 New Service/Power Supply 0- 400 ampere �$35
Nerro Dwelling Servi�/Power Supply 401 - 800 ampere (� $60 Newr Service/Power Supply 401 - 800 ampere (� $60
New Dwelling Feeders/Circuits New/Extended Feeders/Circuits - Up to 15 FeederslCircuits
- tJp to 30 FeederslCircwis -
Nevv Home - l�lore than 30 FeederglCircults �n addiUon to
above) ( ) FeederslCircuits Up To 200 A $6 Eai
Other (Specify)
DetacF�� Garage or Other Associated Structure
Near Servioe/Power Suppty 0- 400 ampere �$35
New Feeders/Circuits ( ) � $6 Each
00
to
Detach� Garage or Other Assxiated Structure
New Service/Powler Supply 0- 4Q0 ampere �$35
New/Extended Feeders/�ircuits ( ) @ $6 Each
Re�nnected Feeders/Clrcuits ( ) � $2 Each
other (Specify) -- - -- Other {SPeciy) _ _` - - — — - —
Totel (the fee calculated above or $35 multiplied TO'tal (the fee calcutated above or $35 multipiied
by the number of required inspection trips, by the number of requfred inspeotion trips,
whichever is greater) whichever is greater) $35 4�Jv
Requests tor Eleetrical lns{�Ctlon (REI) with a tee of $Zb0 or less expire 12 months irom the flling tlate. The co�ractor must have the work Wmpleted withln
the 12 morrth �riad or submft another REI that Irrcludes the Inspection fee for the uncompleted work. Inspectton fees do rwt carry over frod� orre REI to
another.
A service charge oi $SO will be added for all dishonored check�.
I hereby certify that I 6ispeded the electrical installation herein on the dat� �ated: For Department Use Only
Rough - In Inspection(s) Date G��— ��3 pC� ��� A� 1��0�
1�C G
�nspeciion
This material can b�-rrr�de available in
TDD (651) 297-4198.
REI 02 (6/0�
Date
� , Z,g- �
such as large prir�t, Braille or on a tape. To request,
or