P - 75398� Minnesota Depat`tment of Labor and Industry
443 Lafayette Rsoad North
St Paul, MN , 5155-4342
Phone: (651ti��'284-5064
TfY/MRS: ���-51)297�198
www.ele , -dy.state.mn.us
Con ctor Re uest for Electrical
Date Rough-In Inspection Required?
10/22/08 �Contractor N
Address of Inspection — Street
515 66TH AVE. NO.
Owner Name
HENRY MARTIN
Owner Telephone Number(s) —
Contractor Name
L 8� R ELECTRIC ICN.
Contractor Telephone Num
(952) 882-9828
C�tractor Authorized S�n
Code(s)
tion — One Famil � Dwellin
y� Single Inspection Other Than
�ctions Contractor Must Schedule All
FRIDLEY
2- G.F.I. RECEPT.
NEW SERVICE 150 AMP.
ANOKA
Contractor Mailing Address
509 W. TRAVELERS TR. BURNSVILLE, MN. 55337
Contractor E-mail Address � Electrical Utility
LRELECTRICCa�INTEGRAONLINE.0 IEXCEL
�ntractc License Number Job/Project
�- �c��-�
Fee Calculation
Plew Home or Associated Structure
New Dwelling ServicelPower Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401— 800 ampere �$60
New Dwelling Feeders/Circuits
Up to 30 Feeders/Circuits -
Home — More than 30 Feeders/Circuits (in addition to
a1( 1 Feeders/Circuits Uo To 200 A Ca� $6 Eai
Detached Garage or �ther Associated Structure
New Servic�/Power Supply 0- 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
ated Structure
Q Ready Now
�ns ❑ Will Schedul
Existing HomelStructure Remodel or Addition
New Service/Power Supply �LS 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits
— More Than 30
its Un to 200 A i
( ( � ) Feeders/Circuits @ $2 Each �
Detached Garage or Other Associated Structure
New Servic�/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Feede�/Circuits ( ) @ $2 Each
Other iSpecifY)
$35
�
$12
Tot11(the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied y � y�
by the number of required ins�ction trips, by the number of required inspection trips, �,8
whichever is greater) whichever is greater)
Requesffi for Eiectrical Inspectlon (REI) with a fee of $250 or I�s expire 12 months from the flling date. The coMractor must have the work completed within
the 12 month period or aubmlt another REI that includes the ir�pection fee for the uncompleted work Ins�ction feea do not carry over from one REI to
another.
A s�rvice charge of $30 will be added for ail dishonored checks.
1 I.e.eh....oAiQ• �hn{ 1�.,Q.,e,.�� rtio oi«.►r;,�i �„arAu�n�� hArAto �n the dates steted: For De 811t s Oniy
Rough — In Inspeetion(s)
ThIs materlal can be made
TDD (651) 297�4188.
REI 02 (6/0�
Date �� /� � ��� �
�% CD B
Date �� �lrT � � �000
p �-� - d -- - -- -
such as large p�lnt, raille or on a tape. To requ�t, call 1-800-342-6354 (DIAL-DLI) Voice or