P - 75214Minnesota De
443 Lafayette
St. Paul, MN
Phone: (65�
TTY/M RS;�
of Labor and Industry
1) 297-4198
.state.mn.us
Contractor/Re �istered
Rough-In Inspection Required?
11 /2/07 ContractodEm lo er Must Schedule All Rc
Address of Inspection — Street
601 61 ST AVE - SITE# A100819E
Owner Name
T MOBILE
Owner Telephone Number(s) - Include Area Code(s)
(952) 833-4093
MILL CITY ELECTRIC, INC
Contractor/Employer Telephone �
(�12) 724-4900
Servic�/Power Supply
Service/Power Supply
Service/Power Supply
�ignature
�
t�C'D NOU 3 2007
�0�� "��'
m lo er Re uest for Electrical Ins ection
❑ Yes Single Inspection Other Than Rough-In: � Ready Now
h-In Ins ections ContractoNEm lo er Must Schedule All Final Ins ections 0 Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description
INSTALL ONE CIRCUIT FOR CELL EQUIPMENT
ContractodRegistered Employer Mailing Address
332918TH AVE S MINNEAPOLIS MN 55407-2324
ContractoNEmployer E-mail Address Electrical Utility
sheila-mce�comcasfi.net XCEL
Contractor License Number Job/Project Contact Person
CA04101 MATT CINA
Fee Calculation
0 — 400 ampere @ $35
401 — 800 ampere @ $60
Above 800 ampere @ $100
New/Extended Feeders/Circuits Up To 200 A( )@$6 Each
Feeders/Circuits Above 200 A (
Reconnected Feeders/Circuits (
Manufactured Home Park Lot Supply (
Technology System Devices ( 1 )@ 75¢ Each
Separate Bonding Inspections for Swimming Pools and
Equipotential Planes ( ) @ $35 Each
Center Pivot Irrigation Booms ( )@$35 Each
Luminaire Retrofit Modifiqtions ( )@ 25¢ Each
) @ $15 Each Concrete-Encased Eleotrode Inspection ( ) @ $35 Each
Investigative Fee $70 Or The Total Inspection Fee,
) @ $2 Each
Whichever Is Greater U To $1 000
Special Inspection Fee ( ) Hours @$80 Per Hour
) @ $35 Each
Plus Miles The IRS Milea e Rate of
Other
Circuits Ori inatin in the E ui ment $6 Each
Street, Parking Lot, Lighting S4andard ( )@$5 Each OV2f 6OO VOItS — Add the combined asrvicelpower suppty end feeder/cird�R tee to
result in double the regular fee (does not eppty to elechic aign and outtine IigMmg)
( ) New Multi-Family Dwellings @ $70 Each
$0.75
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 TOt81(the fee calculated above or $35 multiplied
Transformers/Power Su lies $5 Each by the number of required inspection trips, $35.5t
whichever is greater)
Requests for Electrical Inspectlon (REI) with a fee of $260 or less expire 12 months firom the flling date. The contractor/employer must have the work
completed withln the 12 month period or submit another REI that includes the Inspedtlon fee for the uncompleted work. Inspectlon fees do not carry over
from one REI to anpther.
A servico char e of $30 wlll be added or aIl dishonored checks.
I hereby certify that I inspected the electrical installaUon herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date ,
F�
This material can belrt�de available
TDD (651) 287-4198.
oc� n� icin��
Date '
= f� � �:
h as larae o
or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or