P - 76898Minnesota Department f Labor and Industry
443 Lafayette Road rth
St. Paul, MN 551 -4342
Phone: (651) 5064
TTY/MRS: ( ) 297-4198
www.eled ' .state.mn.us
Cont ctor Re uest for Electrical t
Date Rough-In Inspection Required?
8/17/2007 Contractor Must Schedule All Rou 1
Address of Inspection — Street
158 63 1/2 WAY NE
Owner Name
ED 8� ARLIE EPSCY
Owner Telephone Number(s) — Indude Area Code(s)
(763) 571-2911
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BRYAN BERG ELECTRIC
Contractor Telephone Number
(763) 286-9622
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ns ection — One Famil Dwellin /Associated Structure
✓ Yes Single Inspection Other Than Rough-In: Ready Now
i-In Ins�ections ConVactor Must Schedule All Final Inspections ❑ Will Schedule
FRIDLEY � ANOKA
Projed Description
WIRE ADDITION TO HOUSE, ADD 100A S�kidEL
WIRE KITCHEN REMODEL
3416 AADLAND AVE NE 1!'
Contractor E-mail Address
bryanberg@juno.com
Contracior License Number
CA03186
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
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Utility
,loa/Projec��ootact Pecson
BRYAN BERG
Fee Calculation � ' C -�
O
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Dwelling Feeders/Circuits
Home — More than
Other
to 30 Feeders/Circuits - $
slCircuits (in addition to
s Uo To 200 A CtD $6 EaCh
Detached Garage or Other Associated Structure
New ServicelPower Supply 0— 400 ampere � 335
New Feeders/Circuits ( ) @ $6 Each
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere (LD $35 $35
New Service/Power Supply 401 — 800 ampere (f� $60
New/Factended Feeders/Circuits — Up to 15 Feeders/Circuit,s
10 Feeders/Circuits 36 Ea� o� �6 fo 30 a100 $60
��e...IC.won.lud Feerlor�N'irr� �ife _ Mnro Than �(1 FaoAr±rc/(:im�its
( ) Feeders/Circuits � $2 Each �
Detached Garage or Other Associated Structure
New Service/Power Suppty 0— 400 ampere @ S35
New/Extended Feeders/Circuits ( ) � $6 Each
Reconnected Feeders/Circuits ( ) � $2 Each
Other (Specify)
TOt81(the fee calculated above or $35 multiplied Totel (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspedion trips,
whichever is greater) whichever is greater)
Requeats for Electrfcal Inspecfion (REI► with a fee of 5250 or Iess expfre 12 months from the fill�g dffie. 7t�e ca+fractor must have the woric
the 12 morrth period or submit another REI that Includes the Inspection fee for the uncompleted work. lnspection fe� do not carry over 1
another.
A Service charge of iS0 wNl be added for all dishonored checka.
1 hereby certiy that I inspected the electricel installation herein on Uie dates stated: For Deparhnent Use Only
Rough — In Inspection s) Date I
i1 �,
Inspedion
This material can b�
TDD (661y 297-4198.
RE� 02 (6/07)
� � �� �°7 I
available in dHterern forms, such as large print, Brallle or on a tape. To request, call
$95 ,�`� U
pleted wkhl�
one REI W .
vo�ce or