P - 75509Minnesota Depa nt of Labor and Industry
443 Lafayette Ro North
St. Paul, MN 5 342
Phone: (651) 5064 � I p�33
TTY/MRS: ( ) 297-4198 C
www.electri .state.mn.us
Contr ctor Re uest for Electrical Ins
Date Rough-In Inspection Required?
09/03/2008 Contractor Must Schedule All Rou h-In
Address of Inspection - Street
1357 53RD AVE NE
Owner Name
THOMAS TRYGG
Owner Telephone Numb
(763) 571-5143
CENTERPOINT ENERGY
Contractor Telephone Number
(763) 757-6202
Contractor Authorized Signature
Area Code(s)
tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: ❑ Ready Now
:ctions Contractor Must Schedule All Final Ins edions � Will Schedule
City/Township County
FRIDLEY HENNEPIN
WIRE/ RECONNECT FURNACE AND AIR
CONDITIONER
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utility
joann.zinken@CenterPointEnergy
Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
or Associated Structure
New Dwelling Service/Power Supply 0�40 re @$35
New Dwelling Service/Power Supply 401 - 800 ampere @$60
New Dwelling Feeders/Circuits
- $100
- More than 30 Feeders/Circui
) Feeders/Circuits Up To
Detached Garaae or Other Associated Structure
New Service/Power Supply 0- 400 ampere @$35
New Feeders/Circuits
Other (Specifv)
Other (Specify)
( ) @ $6 Each
Existing Home/Structure Remodel or Addition
New Service/Power Supply
New Service/Power Supply
0 - 400 ampere @ $35
401 - 800 ampere @ $60
Gs = Up to 15 �eeders/Circuits- -
$6 Each or 16 to 30 @$100
_ Mnra Than 3f1 Faarlarc/Cirr�iitc
Feeders/Circuits U to 200 A $6 Each
Reconnected Feeders/Circuits
sf...'-�� 2 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 (Soecifi�)
Total (the fee calculated above or $35 multiplied TOtel (the fee calculated above or $35 multiplied O
by the number of required inspection trips, by the number of required inspection trips, ��,�
whichever is greater) whichever is greater)
Requests for Electrical Inspectlon (REI) wfth a fee of $250 or less expire 12 months from the flling date. The contractar must have the work eompleted wlthin
the 12 month pertod or submtt another REI that Includes the InspecUon fee for the uncompleted work. lnspectfon fees do not carry over from one REI to
another.
A service charge of $30 wlll be added for all dishonored c cks.
I hereby certify that I inspected the electrical installaUon herein on the dates stated: For Departme t Use Only
Rough — In Inspection(s) Date �,�,����,�
Thls materfal can b�
TDD (651) 297�198.
REI 02 (6/0�
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such as
or on a
�C'D SEP 0 � 2008
or