P - 75519Minnesota Departrnent of Labor and Industry
443 Lafayette Rc��dd North
St. Paul, MN 5��1�55-4342
Phone: (651) , 5064
TTY/MRS: ( ) 297-4198
www.electric' .state.mn.us
Contr tor Re uest for Electrical I
Date Rough-In Inspection Required?
8/15/2008 Contractor Must Schedule All Rou I
Address of Inspecdon — Street
742 58TH AVE NE
ROSEMARY BIEDRON
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Contractor Name
AID ELECTRIC
Contractor Telephone Number
(763) 57�67 � ,
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V�
;tion - One Famil / Dwellin /�
Yes Single inspection Other Than Rou
FRIDLEY
Project Description
NEW SERVICE
Contractor Mailing Address
1622 93RD LANE NE, BLAINE, MN 55449
EL
c� � e 7 8`1
.I�P►L�T.�
Structure
] Ready Now
] Will Schedule
Contra ho� Sig ure Contractor License Number Job/Project Contact Person
CA03199
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0— 400 ampere @$35 New Service/Power Su ply� 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60 New Service/Power Supply 401 — 800 ampere @$60
New
to 30 Feeders/Circuits - $100
s/Circuits (in addition to
� Uo To 200 A C�D $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) � $6 Each
Other (Specify)
or16to30Ca)$100
Reconnected Feeders/Circuits
( � � ) 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
$35
Total (the fee ca:�ulated above or $35 multiptied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, $35
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the flling date. The contractor must have the work completed within
the 12 month period or submk another REI that includes the InspecUon fee for the uncompleted work. InspecUon fees do not carry over from one REI to
another.
A service charge of $30 wfll be added for all dishonored checks.
I hereby �rUfy that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date /
�
This matehal can bE
TDD (651) 297-4198.
REI 02 (6/0'�
Date
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