P - 76720Minnesota D rtment of Labor and Industry
443 Lafayett oad North
St. Paul, M 55155-4342
Phone: (6 ) 284-5064
TTY/MR (651) 297-4198
www.ele icity.state.mn.us
Contractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
12/07/2007 Contractor Must Schedule All Rou h-In I
Address of Inspection — Street
937 68TH AVENUE NE
Owner Name
SHANNON FURLONG/ BRIAN NELSON
Owner Telephone Number(s) - Include Area Code(s)
(763) 221-8237 (763) 807-9285
Contractor Name
CENTERPOINT ENERGY
Contractor Telephone Number
(763) 757-6202
re
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REC'D � F('. 14 20 7
tion - One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: � Ready Now
�ctions Contractor Must 5chedule All Final Ins ections ✓❑ Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description
WIRE/RECONNECT FURNACE
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utility
joann.zinken@CenterPointEnergy
Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
or Associated Structure
Fee Calculation
Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0— 4 mpe[� @$35 I I New Service/Power Supply
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Dwelling Feeders/Circuits
Up to 30 Feeders/Circuits - $
New Home — More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A@$6 Each
Other (Specify)
Detached Garage or Other Associated Structure
New Service/Power Supply
New/Extended Feeders/Circuits
( ) Feeders/Ci[cuits @ $
New/Extended Feeders/Circuits —
( ) Feeders/Circuits
Reconneci�d Feeders/Circuits
0 — 400 ampere @ $35
401 — 800 ampere @ $60
— Up to 15 Feeders/Circuits
6Eachor16to30@$100
More Than 30 Feeders/Circui
Up to 200 A(a� $6 Each
( �1 ) Feeders/Circuits $2 Each I $2
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35 I I New Service/Power Supply 0— 400 ampere @$35
iJew FeedersiCircuits ( } @ $6 Each
viner �speciry�
Other (Specify)
New/Exter���d Feed2rs/Circu+ts ( ) �c $S Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Total (the fee calculated above or $35 multiplied Total (the fee calculated atiove or $35 multiplied �
by the number of required inspection trips, by the number of required inspection trips, �� s. SC�
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The contractor must have the work completed within
the 12 month period or submit another REI that includes the inspection fee for the uncompleted work. Inspection fees do not carry over from one REI to
another.
A service charge of $30 will be added for all dishonored checks.
I hereby certify that I inspected the
Rough — In Inspection(s)
This maYerial can b�
TDD (651) 297�798.
REI 02 (6/07)
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e in different forms, such as large pri
For
or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or