P - 75413Minnesota Department of Labor and Industry
443 Lafayette Road,- orth
St. Paul, MN 55 -4342
Phone: (651) 5064
TTY/MRS: ( ) 297-4198
www.ele ' .state.mn.us
Contractor/Re i:
Date Raugh-In Inspection Required?
10/28/2008 ,.........�._.,�__,_..__...._. �_�_
nYU1C.l.7 VI IIIDt,lCliUUll - JUCCI
1626 68TH AVENUE NORTH
RICE CREEK TOWNHOMES
Owner Telephone Number(s) – Incl�
Contractor/Registered Employer Name
SOUTH SIDE ELECTRIC, INC.
Contractor/Employer Telephone Number
(952) 888-5500 /'
,���11/ D �
Employer Request for Electrical I
I—I Yes Single Inspection Other Than Rough•
le All Rou h-In Ins ections ContractoNEm lo er Must Schedule All Final Ins dions U
Cityrfownship County
FRIDLEY ANOKA
Project Description
REPLACE 200 AMP SPLIT METER SOCKET.
ide(s) REFEED EXISTING 100 AMP ITE PANEL.
MISC. WIRING PER LIGHTNING DAMAGE.
Contractor/Registered Employer Mailing Address
9201 E. BLOOMINGTOIV FRWY, BLOOMINGTON, MN 55420
Contractor/Employer E-mail Address Electrical Utility
Co oyer utho ' d Signature ^ Contractor License Number Job/Project Contact Person
CA01695 952-292-8423
°�� Fee Calculation
Service/Power Supply 0– 400 ampere @$35 $35 Technology System Devices ( )@ 75¢ Each
Service/Power Supply 401 – 800 ampere @$60 Separate Bonding Inspections for Swimming Pools and
E ui otential Planes $35 Each
Center Pivot Irrigation Booms ( )@$35 Each
Service/Power Supply Above 800 ampere @$100
Plus Electrical Drive Units $5 Eacl
New/Extended Feeders/Circuits Up To 200 A( )@$6 Each Luminaire Retrofit Modfications ( )@ 25¢ Each
Feeders/Circuits Above 200 A ( )@$15 Each
Reconneded Feeders/Circuits ( 20 ) @ $2 Each
Manufactured Home Park Lot Supply ( )@$35 Each
Ready Now
Will Schedule
Concrete-Encased Electrodelnspection( ) @ $35 Each
Investigative Fee $70 Or The Total Inspection Fee,
Whichever Is Greater U� To $1
Plus ( ) Miles @ The IRS Mileage Rate of
Other
Circuits Ori inatin in the E ui ment $6 Each
Street, Parking Lot, Lighting Standard ( )@$5 Each OV@� FiOO VOItS — Add the combinad seMce/power aupply and feededclrcuft tea to
result in double fhe raguleriee (does not apply to etectric sign and ouUine lightlng)
Transformers Up to 10 kva ( )@$15 Each � ) New Multi-Family Dwellings @$70 Each
Wdh Up To 20 Feeders/Circuits
Transformers Over 10 kva ( )@$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
6 Each
Electric Signs and Outline Lighting Totel (the fee calculated above or $35 multiplied
Transformers/Power Su lies $5 Each by the number of required inspection trips,
whichever is greater) $75.50
Requests for Electrlcal Inspectlon (REI) wlth a fee of $2b0 or I�s explre 72 months from the flling date. The contractor/employer must have the work
completed wlthln the 12 mor�th perlod or submk another REI that Includes the Inspectlon fee for the uncompleted work. Inspectlon fees do not carry over
from one REI to another.
A service cha e of $30 wlll be added for all dlshonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated: For Depar6nent Use Only
Rough – In Inspection(s) Date �/ �/� �...�� �'1f'1
�V O`lJ
Final Ins on Date �� D C C 0 2 ZOOS
r �G �
�hls r an e ade ava I le In dtfferent forms, su h as large print, le or on a tape. To request, call 1-800,342-5354 (DIAL-DLI) Volce or
TDD (651) 297�4198.
REI 03 (6/07)