P - 75211Minnesota Departrn nt of Labor and Industry
�- �43'tafayette R North
St. Paul, MN 55-4342
Phone: (65 �' 84-5064
TTY/MRS: � 51) 297-4198
www.ele city.state.mn.us
ContractoNRe istered Em
Date Rough-In Inspection Required?
03-31-2008 ContractoNEm lo er Must Schedule All Rou h-1r
Address of inspecfion - Street
501 67TH AVE NE
BROTHERS ADDITIONS & DECKS, LLC
Owner Telephone Number(s) - Include Area Code(s)
(715) 247-2742
STABNER ELECTRIC INC
ContractoNEmployer Telephone
� - -- - - --- —
(651) 429-9398
t Co �_ ct�r/Em�e`, ut ized
Servic�/Power Supply
Service/Power Supply
�ervice/Power Supply
,�- � � -° �
�er Request for Electrical Inspection
Yes �Single Inspection Other Than Rough-In:
ContractoNEm lo er Must Schedule All Final Ins ecUons �
City/Township County
FRIDLEY ANOKA
Project Description
ADD SWITCH, OUTSIDE LIGHT, OUTSIDE
RECEPTACLE
PO BOX 476 HUGO MN 55038
Contractor/Employer E-mail Address
CA01711
Fee Calculation
0 - 400 ampere @ $35
401 - 800 ampere @ $60
Above 800 ampere @ $100
New/Extended Feeders/Circuits Up To 200 A( )@$6 Each
Feeders/Circuits Above 200 A (
Reconnected Feeders/Circuits (
Manufactured Home Park Lot Supply (
( ) Circuits Originating in the Ec
Street, Parking Lot, Lighfing S�ndard (
Transformers Up to 10 kva (
) @ $15 Each
) @ $2 Each
) @ $35 Each
@ $6 Each
) @ $5 Each
) @ $15 Each
NA -- - - -- -
Job/Project Contact Person
NATE 651-270-9903
Technology System Devices (
Equipotential Planes (
Center Pivot Irrigation Booms (
�� Plus ,� � (•_ ) Ele�trical
Luminaire Retrofit Modifications (
) @ 75¢ Each
�q Pools and
) @ 25¢ Each
Ready Now
Wlll Schedule
Concrete-Encased Electrode Inspection ( ) @ $35 Each
Hours CaD_ $80 Per Hour
Over 600 Volts — ndd the commned service/power suppry end reedenarcuit ree co
resutt in doubla the regular fee (does not apply W elearic sign and ouUirte IlghUngj
With Up To 20 Feeders/Circuits
Transformers Over 10 kva ( )@$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
$6 Each
Electric Signs and OuUine Lighting Total (the fee calculated above or $35 multiplied
Transformers/Power Su lies $5 Each by the number of required inspection trips, $35.50
whicliever is greater)
i �
Requesffi for Electricel Inspectlon (REI) with a fee of $250 or less expire 12 m nths from thp filing date. The contractor/employer must have the work
completed within the 12 month pertod or submft another REI that includes the ' pectlon fee for the uncompleted work. InspecUon fees do not carry over
from one REI o another.
A service cha e of $30 will be a ded for aIl dishonored checks.
t hereby certify that I inspected the electrical installation herein on the dates atated: For Department Use Only
Rough - In Inspection(s) Date
Final Inspection Date REC'D APR 0�' 2008
3_ a�' 2 pa�- Ub 3� �
I'hls materlal can made avallable in dlfferent forms, such as large print, Brallle or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or
TDD (651) 297-4198.
REI 03 (6/0�