P - 75521��
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Minnesota Depa ent of Labor and Industry
443 Lafayette `�ad North
St. Paul, MN 155-4342
Phone: (651) 5064
TTY/MRS: ( ) 297-4198
www.electric .state.mn.us
Contra tor Re uest for Electrical I
Date Rough-In Inspection Required?
Contractor Must Schedule All Rou I
Address of Insaection - Street
0
Contractor Name
Lazer Electric
Contractor Telephone Number
763-784-3729
Contractor l�orized Signature
/ di . �
REC'D J U L 1� 2��%
�GZS`? -�/ � �
�tion — One Family Dwelling/Assc
y� Single Inspectlon Other Than Rough-in:
sctions Contractor Must Schedule All Final Ins
Cit�r/Township Counr
1�.�-�- Iv�e.�.s �4°,�.�-
Area Code(s)
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Contractor Mailing Address
8164 Arthur St. NE, Sprinq Lake Park, NIlV
Structure
Ready Now
] Vllill Schedule
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CA01110 � Chuck Schwieters
Fee Calculation
New Home or Associated Structure
New Dweifing Service/Power Supply 0- 400 ampere @$35
� � C �—
New Dwelling Service/Power Supply 401 - 800 ampere @$60
New Home - More than
- $100
To 200 A Cc� $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0- 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Exlsting Home/Structure Remodel or Additlon
- New Service/Power Supply
�
New Service/Power Supply
0 - 400 ampere � $35
�^1 - 800 ampere @ $60
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
(`�tai (the fee calculated above or $35 multiplied Totet (the fee calculated above or $35 multipifed
by the number of required inspection fips, by tha number of required inspection trips, �
whichever is greater) whichever is greater)
Requests for Eleetrical Inspectlon (REI) with a fee of:250 or less explre 12 months from the fl1ing date. The eontractor must have tha work compisted within
the 12 month psriod or submit another REI that ineludes the inspectlon fee for the uneompleted work. in9pection fees do not carry over irom one REI to
another.
A service charge of 530 will be added for ali dishonored checks.
I hereby cert(fy that I ins ed the electrical installaUon herein on the dates steted: For Department Use Only
Rough/%�nsp� ctI � (s���— "/ _ , �- Date �
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Thts matarial can be made avaflabis i different forms, such as la
TDD (651) 297-4198. � f v- 3�'
REI 02 (6/07)
or on a
va��e ar