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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 � 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