P - 76735Minnesota Departm�nt of Labor and Industry
443 Lafayette Ro `North
St. Paul, MN 55 " 5-4342
Phone: (651) -5064
TTY/MRS: ( ) 297-4198
www.electri .state.mn.us
Cont ctor Re uest for Electrical Ins
Date Rough-In Inspection Required? I
2-15-08 Contractor Must Schedule All Rou h-In li
Address of Inspection — Street
5201 3RD STREET N.E.
Owner Name
APARTMENT #302
Owner Telephone Number(s) — InGude Area Code(s)
(651) 387-6117
Contractor Name
MUSKA ELECTRIC COMPANY
Contractor Telephone Number
(651) 636-5820
Con�cectq A �hori�e�i Signature �
� r i
tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: Ready Now
:ctions Contractor Must Schedule All Final Ins�ections n Will Schedule
FRIDLEY � ANOKA
Project Description
J-23727 CHANGE OUT PANEL
Contractor Mailing Address
1985 OAKCREST AVEUE, ROSEVILLE, MN 55113
Contractor E-mail Address Electrical Utility
Contractor License Number
CA01287
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 L�welling FeeaersiCircuits
Up to 30 Feeders/Circuits - $100
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 Service/Power Supply
New Feeders/Circuits
Other (Specify)
Other
0 — 400 ampere @ $35
( ) @ $6 Each
Job/Project Contact Person
KEITH PETERSON
Existing Home/Structure Remodel or Addition
New Service/Power Supply
New Service/Power Supply
New/Extended Feeders/C�r�
( ) Feeders/Circuits
New/Extended Feeders/Ciro�
( 8 ) Feeders/Cir
Reconnected Feeders/Circ�
0 — 400 ampere @ $35
401 — 800 ampere @ $ti0
iis — Up to 15 Feeders/Circuifs
>$6Eachor16to30@$100
- More Than 30 Feeders/Circui
iits Uq to 200 A Cc� $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
$48
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, �48
whichever is greater) whichever is greater)
Requests for Elect�ical Inspection (REI) wlth a fee of 5250 or less expire 12 months from the filing date. The contractor must have the work completed within
the 12 month perlod 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 530 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
Final Inspection
,s
This material can be made
TDD (651) 297-4198.
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RECD F � � 21 2008
or on a tape. To request,
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