P - 75480Minnesota Depart nt of Labor and Industry
443 Lafayette Ro ;' North
SL Paul, MN 55 ' -4342
Phone: (651) 2 -5064
TTYlMRS: (6 297-4198
�r.electrici tate.mn.us
Date j Rough-In Inspection Required?
09-29-08 � Cnn4r�n4nr/Gmnlnvnr AAneF Cnh.
^��� o�� �� �� ��Na����� � — ,
643 - 53RD AVE NE
DALE SORENSEN
Owner Telephone Num
(763) 572-9025
HEIGHTS ELECTRIC, INC.
-- ---{7Fi3} 788��8
Service/Powar Supply
5eroice/Powrer Supply
Service/Powier Supply
�
Em lo er Re uest for Electrical Ins ection
Yes Singte InspecBon Other Than Rough-In:
u h-In Ins tions ContractodEm lo er Must Schedule All Final Ins ectic
City/Townshlp Counry
FRIDLEY ANOKA
Ready Now
Wiil Schedule
RESIDENTIAL SERVICE UPGRADE. OVERHEAD 100
AMP, 120/240 VOLT
�actonKegisterea tmpioyer nnamng aadress
- 40TH AVE NE COLUMBIA HEIGHTS, MN 55421
�trt€R�l�- - - -
� �CAOQ827 � BILL KNOTTS 763-286-2481
Fee Calculation
0— 400 ampere @$35 $35 . Technology System Devices •( )@ 75¢ Each
401 — 8U0 ampere @$60 Separate Bonding Inspections for Swimming Pools and
Eauiootential Planes ( 1 CaU $35 Each
Above 800 ampere @ $100
Pdew/E�ctended Fe�c7ers/Circaits Up To �0���-@ 56�c�t
Feeders/Circuits Above 200 A ( )@) $15 Each
Reconnected FeederslCircuits ( 11 ) @ $2 Each
Manufactured Home Park Lot Supply ( )@$35 Each
{ ) Gircuits Origina6ng in the Equipment �$6 Each
Street, Parking Lot; Lighting Standard ( )@$5 Each
Pius Electrical Drive Units $5 Each
� L�m�n�re ReSoTit�Nfo�ications ( ) @ 25¢ Each
Concrete-Encased Electrode Inspection ( ) @ $35 Each
Investlgative Fee $70 Or The Total Inspection Fee,
�22 Whichever Is Greater U To $1,000
Special InspecUon Fee ( ) Hours @$80 Per Hour
Plus Milas The IRS Milea e Rate of
Other
State Surcharge $ .50
Over 600 Volts —,wd me combmea ser�Icelpowersuppry ana reeuenctrcunrse ro
result In double the regularfee (does not appty to elecMc sign end outiina lighting)
( ) New Multi-Family Dwrellings @ $70 Each
Transformers Up to 10 kva ( )@$15 Each
With Up To 20 Feeders/Circuits
Transformers Over 10 kva ( )@$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
6 Each
Electric Signs and Outline Lighting Total (the fee calculated above or $35 multiplied
Transformers/Powrer Su lies $5 Each by the number of required inspecUon trips, ��7 , 50
whichever is greater)
Requests for Electrfcal inspection (REI) with a tee of;250 or less expire 12 months from the flling date. The contractor/empioyer must have the work
completed wfthln the 12 mortth period or submit another REI that Inciudes the inspection fee for the uncompleted vuork. Inspecllon tees do not carry over
from one REI to another.
A,service chaz of S30 wili tre added for all dishonared checks.
I hereby certffy that I inspected the electrical InstallaUon herein on the datss stated: For Department Use Only
Rough — In Inspection(s) Date , A
�'j —� �� "" C 1
Final Inspection Date
p. Tl1
This material can be made available in difierent forms, such a large print, Braille n tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or
TDD (651) 297-4198.
RE103 {6/07)