P - 76823Minnesota Departmen of Labor and Industry
443 Lafayette Road rth
St. Paul, MN 55 -4342
Phone: (651) 5064 /���
TTY/MRS: ) 297-4198 �-, �`�
www.elect y.state.mn.us ��
Contractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
11 /06/2007 Contractor Must Schedule All Rough-In
Aaaress or mspecnon —
20 64TH WAY NE
Owner Name
ROBERT SMITH
Owner Telephone Number(s) — Include Area Code(s)
(7Fi�l .�i71-fi174
Contractor Name
(:FNTFRP(�INT FNFRC�Y
Contractor Telephone Number
(763) 757-6202
Authorized Signature
a���-oa��
�C'� � � � 13 2007
tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: � Ready Now
:ctions Contractor Must Schedule All Final Ins ections ✓❑ Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description
WIRE/ RECONNECT FURNACE AND AIR
CONDITIONER
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utility
joann.zinken@CenterPointEnergy
Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
ew Home or Associated Structure
t
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New Dwelling Service/Power
Fee Calculation
Existing Home/Structure Remodel or Addition
@$35 I I New Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Home — More
p to 30 Feeders/Circuits - $100
:rs/Circuits (in addition to
its U� To 200 A CD $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
l�:sw F�edsrs/Circui!s { 1 � $6 Fach
(Specify)
New Service/Power Supply
its
New/Extended
401 — 800 ampere @ $60
ts — Up �o�bFe3e�s/�cuifs
$6 Each or 16 to 30 @$100
— More Than 30 Feeders/Circui
its Uo to 200 A(c� $6 Each
nected Feeders/Circuits
( 2 ) Feeders/Circuits @ $2 Each $4
Detached Garage or Other Associated Structure
New Senrice/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Tot81 (the fee calculated above or $35 multiplied Tot81(the fee calculated above or $35 multiplied 50
by the number of required inspection trips, by the number of required inspection trips, ��J �
whichever is greater) whichever is greater)
Requests for Electricat Inspection (REI) with a fee of Sz50 or less expire 12 months from the filing date. The contractor must have the work completed within
the 12 month period or submit another REI that includes the inspection fee for the uncarmpleted work. Inspection fees do not carry over from one REI to
another.
A service charge of E30 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
�%�� � � `��' �
Final Inspectio Date
1�-- o�
This mat ial can be made available in different forms, such as large rint, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or
TDD (651) 297-4198.
REI 02 (6/07)