P - 76737Minnesota Department of Labor and Industry
443 Lafaye oad North
St. Paul, 55155-4342
Phone: 1) 284-5064
TTY/M : (651) 297-4198
www. ctricity.state.mn.us
Contractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
2-19-08 Contractor Must Schedule All Rou h-In
Address of Inspection — Street
1410 66TH AVE N.E.
Owner Name
STEVE LIND
tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: � Ready Now
:ctions Contractor Must Schedule All Final Ins ections ✓Q Will Schedule
City/Township County
FRIDLEY ANOKA
rro�ect uescription
BASEMENT WIRING
Owner Telephone Number(s) — Include Area Code(s)
(763)571-0852
Contractor Name Contractor Mailing Address
HORIZON ELECTRIC 21483 GRENADA AVE #180
Contractor Telephone Number Contractor E-mail Address
(952) 985-8088 m.horizonelectric@frontiernet.net
C.o� ra�r Authorized Signat e Contractor License Number
�'�/.,� �i� /l��- CA02188
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
Up to 30 Feeders/Circuits - $100
New Home — More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A Ccil $6 Each
Other (S
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
Other (Soecifvl
0 — 400 ampere @ $35
( ) @ $6 Each
Job/Project Contact Person
MIKE PETERSON
Existing Home/Structure Remodel or Addition
New Service/Power Supply
New Service/Power Supply
{ 2 ) Feeders/Circuits
New/Extended FeederslCira
( ) Feeders/Circui
Reconnected Feeders/Circuits
0 — 400 ampere @ $35
401 — 800 ampere @ $60
ts — Up to 15 Feeders/Circuits
$6 Each or 16 to 30 @$100
— More Than 30 Feeders/Circui
ts Up to 200 A(cil $6 Each
( ) 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
Other (Specify)
$12
Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips,
whichever is reater $70 ,. �_' ti'�
9 ) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of 5250 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 uncompleted work. Inspection fees do not carry over from one REI to
another.
A service charge of $30 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated: For Department Us� �� F E B 21 2008
Rough — In Inspection Date !��� , ����
_ 2(—��
Final Inspection �— � Date
This material can be made available in
TDD (651) 297�198.
REI 02 (6/07)
such as large print, Braille or on a tape. To request, call 1
Voice or