P - 75720Minnesota Depa nt of Labor and Industry
443 Lafayette R North
St. Paul, MN 55�342
Phone: (65 84-5064
TlY/MRS� 51) 297-4198
www.ele 'city.state.mn.us
Contractor Re uest for Electrical I
Date Rough-In Inspection Required?
7/31/2007 Contractor Must Schedule All Rou I
Address of Inspection — Street
5616 4TH STREET NE
Owner Name
KATHERINE LOUTCHKO
Owner Telephone Number(s) — Include Area Code(s)
(763) 571-7333 (763) 443-8359
Yes
REC'D AU G- 3 200�
��U� - C� l `-��C�
— One Familv Dwelli
Single Inspeetion Other Than Rough-In:
Contractor Must Schedule All Final Ins�
FRIDLEY
ANOKA
WIRE/RECONNECT AIR CONDITIONER
Structure
] Ready Now
� Will Schedule
Contractor Name Contractor Mailing Address
CENTERPOINT ENERGY 9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(763) 757-6202 joann.zinken@CenterPointEnergy.co
Con ctor Autho ' d n re Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
to 30 Feeders/Circuits - $
s/Circuits (in addition to
s Up To 200 A CcD_ $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
0 — 400 ampere @ $35
( ) @ $6 Each
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere �$60
New/Extended Feeders/Circuits — Up to 15 �eders/eirccrits-
( ) Feeders/Circuits @$6 Each or 16 to 30 @$100
New/Extended Feeders/Circuits — More Than 30 Feeders/Circuits
( ) Feeders/Circuits Up to 200 A�$6 Each
Reconne�ted Feeders/Circuits
( 1 ) 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
Other (Specify)
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, t�/
whichever is greater) whichever is greater) � �`
Requests for Electrical InspecUon (REI) with a fee of $250 or less expire 12 months from the flltng date. The contractor must have the work completed within
the 12 month period or submit another REI that includes the inspectlon fee for the uncompleted work. lnspection fees do not carry over from one REI to
another.
A servtce charge of $30 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
This material can be made
TDD (651) 297�198.
REI 02 (6/0�
�-d ? �� I
, such as larpe prin� Braille or on a
or