P - 76725�:
Minnesota Depa ent of Labor and Industry
443 Lafayette R d North
St. Paul, MN 5 55-4342
Phone: (651 5064
TTY/MRS: 1) 297-4198
www.elect ' y.state.mn.us
Contractor Re uest for Electrical Ins ectio
Date Rough-In Inspection Required? ✓ Yes
01/02/2008 Contractor Must Schedule All Rou h-In Ins edioi
Address of Inspection - Street
1485 66TH AVE NE � 3=� �
DIANE GUZIK
Owner Telephone N
(763) 571-8599
- One Fami
�1�G1� "G���I
�C'D . �aRl - 3 2��$
Dwellin /Associated Structure
)ther Than Rough-In: Ready Now
:hedule All Final Insoections n Will Schedule
City�Township County
FRIDLEY ANOKA
Project Description
MASTER BEDROOM 8� BATHROOM REMODEL
TRUE BLUE ELECTRIC, INC. PO BOX 120960 - NEW BRIGHTON MN 55112
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(612) 644-2875 kposz@truebiueeieciric.com
Contractor Authorized Signature Contractor License Number Job/Project Contact Person
� � - CA04729 CAROL ANDERSON
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0- 400 ampere @$35
New Dwelling Service/Power Supply 401 - 800 ampere @$�- I__ _
New Dwelling Feeders/Circuits
Other
Up to 30 Feeders/Circuits - $
- More than 30 Feeders/Circuits (in addition to
) Feeders/Circuits Up To 200 A CD_ $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0- 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other (Specify)
New Service/Power Supply 0- 400 ampere @$35
�lew_�rxi�LPo�r�SUpp1y 401 - 800 ampere (c� �60
New/Extended Feeders/Circuits - Up to 15 Feeders/Circuits
2 Feeders/Circuits $6 Each or 16 to 30 $100 $ � 2
New/Extended Feeders/Circuits - More Than 30 Feeders/Circuits
Feeders/Circuits U to 200 A $6 Each
Reconneded Feeders/Circuits
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 (Soecifvl
Totel (the fee calculated above or $35 multiplied TOt11(the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspedion trips, $70 _v
whichever is greater) whichever is greater)
Requests for Electrlcal Inspectlon (REI) wkh a fee of 5250 or less expire 12 months from the filing date. The contractor must have the work completed withln
the 12 moMh period or submit 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 530 will be added for all dishonored checks.
I hereby certify that I inspected the elechical installation herein on the dates stated: For Department Use OnIY
Rough - In Inspection(s)
� �
Final Inspection
iG{ — `.
Thls materlal can be made available In dffferent fi
TDD (651) 29T�188.
REI 02 (6/07)
Date
—/ ( G� .
Date
�- � = �
s, such as large prl
or on a tape. To request, call 1-800-342-5354 (DIAL-DLq Vofce or