P - 76751Minnesota Depa ent of Labor and Industry
443 Lafayette d North
St. Paul, MN 155-4342
Phone: (65 284-5064
TTY/MRS• 51) 297-4198
www.ele city.state.mn.us
Con actor Re uest for Electrical Ins
Date Rough-In Inspection Required?
12/26/2007 Contractor Must Schedule All Rou h-In
Address of Inspection - Street
505 66TH AVE NE
Owner Name
HOWARD B. LARSON
Owner Telephone Number(s) - Include Area Code(s)
(763) 427-1285
Contractor Name C ��,i,�� `kr �` Contractor
� ��� ,��iLU �
f�C'D , I A N- 3 2008
�tion — One Family Dwelling/Assc
Yes Single Inspection Other Than Rough-In:
;ctions Contractor Must Schedule All Final Insn
FRIDLEY
County
ANOKA
NEW SERVICE AND TWO NEW CIRCUIT
CHRIS VAN KREVELEN 11660 BUTTERNUT ST. NW COON RAPIDS, MN 55448
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(763) 221-5648 CHRIS.VANKREVELEN@COMCAS EXCEL
CQntractot Authori d� nature Contractor License Number Job/Project Contact Pe
L ���- i 4, CA05127 CHRIS
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
NewDvveliing F�ederslCtl'�Ult� - - -- — --
U to 30 Feeders/Circuits - $100
New Home - More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A(c� $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0- 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other (Soecifvl
Structure
] Ready Now
] Will Schedule
Existing Home/Structure Remodel or Addition
New Service/Power Supply�U - 400 ampere @$35 $35
New Service/Power Supply 401 - 800 ampere @$60
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
Reconnected Feeders/Circuits
( °� ) 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 FeederslCircuits ( ) @ $2 Each
Other (Speciry) Other (Specify)
SURCHARGE.50 •Sd
Total (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 inspection trips, �7 �-�
whichever is greater) whichever is greater)
Requests for Elect�ical Inspection (REI) with a fee of 5250 or leas expire 72 months from the filing date. The contractor must have the work completed wlthin
the 12 month period or submk another REI that lncludes the inspectlon fee for the uncompleted work. Inspection fees do not carty over from one REI to
another.
A servlce charge of:30 will be added for all dishonored checks.
I hereby cert'rfy that I inspected the electrical installation herein on the dates stated: For Depar[ment Use Only
Rough - In Inspection(s) Date
Final Inspection
/.`� C
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This material can be made available in different forms, su�as large
TDD (651) 297-4198.
REI 02 (6/07)
or on a tape. To request, call 1-800.342-5354 (DIAL-DLI) Voice or