P - 75385Minnesote
443,LefeyE
� St Paul„IN
w�one: �6�
11/09/O7
�nt of Labor and Industry
Narth
) 297-4198
Request for Electr�cal
Rough-fn In�e�ion Require�?
.,�..�� �� ���s�w��� -
125 49TH AVE NE
CHAU NGUYEN
Owner Te�pharte Number(s) -
Cor�traactor Name
TALL TREE ELECTRIC
Contrador Telephone Num�
(763) 78fi-4026
�uv�� — vnra r�
y� Single InsE
�ctions Cor�traac�r
City/Tovrnsh�
FRIDLEY
��b���-�
�CD NOU 14 2007
ANOKA
NEW ATTACHED GARAGE ELECTRICAL
Contractor Mailing Address
14765 Wi410E ST NE H�M LAKE, MIV 553�
CoMrador E-mail Address Eledria
Structure
Reedy Now
L. � CA04838 � DUANE
Fee Calculation
New Home o� Assoclated Structure Existlng Home/Strucd�re Remodel or Addition
New Dwelling �rvice/Pow� Supply 0- 400 emPer� Ca� $35 New Servtcs/Power SuPPIy 0- 400 ert�re ��i5
New D�reUfng Servfoe/Power Supply 401- 8� amp�re @� Wew Servir,BlPawer Suppty ao� — sgo am� ��so
New Dw8Uln9 Feeders/CirWits Ne�/Extend�d F�±r1o,mlf:�rr_��trn _ �►n �n � G r��ir_i.M��
- — - - - --- Ua to 3�Fe�eisJCi�da -
Ne�r Home - More then �D Feeder�Cinwi� (in addiUan to
Det�ched Garage or Other Ass�iated Structur�
New Service/PoNaer Suppty 0- 40D ampere �$35
New F�ders/Circuits ( ) (� $6 Eat�
to 200 A
De�ched Ga�age or Other A�lat� Structure
Plew SenricefPowaer Supply 0- 400 ampere (d� $35
NewlE�dended Feeders/Circv�s ( ) Q � Eadi
Re�nnecte� Feeders/CUcu�s ( ) C $2 Each
$12
TOtel (the fae calaitated abave or $35 mul�plted Toidl (the fee calailated sbove or $35 mu(tiplied
by the number of requ[r�a1 �on trips, by the number of r�uired ins�ctlan trips, $35
whfchevet i.a 9���) whidtever i� 9reate�
Req� ta' E�1�1 ��pe�on (REiI ar� a fee oi � or la� e�[plre 12 moittl� fran tl�e flifrtg dete. 'fi� contracbor mt�t have ths work emnplebed wiGHn
the 12 morth pertod or submit en�lter REI tliat dtd1�� tlte d�pectlon teB f� Ute u�oml�tebed rerork. lnspeCtlon f� do �t Cerry over irnm are REI to
a�ter.
/Ya C�� c� U��{' S� ��t t W 5�/ �t 1,�5 s�vi � Lci�arge�lt S3o wnt be added tor aA dishonored checi�s.
� F�Y certiir that � inspec�ed tl�e el�l instal►atlon f�n on tt� da� s�d: For Deparhnetn tNe Qnty
Rough - In Inspedion(s) Q�
__ f G �
Finai Inspec�i Date
�' S� ��tf� �r �-�-a�
Thb rt�l can be avaUable In diRereM ibm�. au+� as large prMt, BraUle or on a fape. To reque�t� t�p 1-�2,83b4 (DIAL-0I.q Volee or
'T�D (861) 287rL188.
REI Q't (8/0�