P - 75342Minnesota , partrnent of Labor and Industry
443 Lafaye � Road North
St. Paul, 55155-4342
Phone: ( 1) 284-5064
TTY/M (651) 297-4198
www.e 'citv.state.mn.us
Cofitractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
5/19/08 Contractor Must Sch�ule All Rou h-In
Addr�s of Inspection — Street
5850 6TH ST NE - '"�° -
Owner Name
BONNIE FINLAYSON
Owner Telephone Number(s) —
(763) 571-1284
ERICKSON PHC
Contractor Telenhone Number
Area Code(s)
tion — One Famil Dwellin /Associated Structure
y� Single Inspection Other Than Rough-In: ❑ Ready Now
�ctions Contractor Must Schedule All Final Ins ions ✓❑ Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description
REPLACE FUSE PANEL WITH CIRCUIT PANEL.
REPLACE GF�'S AT LOWER LEVEL BATH & KITCHEN
Contractor Mailing Address
1471 92ND LANE NE BLAINE, MN 55449
Contractor E-mail Address Eleci
c:o r Auth z 5ign ure Contractor License Number Job/Project Contact Person
� CA02266
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0— 400 ampere @$35 New Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60 New Service/Power Supply 401 — 800 ampere @$60
New Dwelling Feeders/Circuits New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits
— More than 30
Other
200 A
s-
t0
Detached Garage or Other Associated Structure
New SeMce/Power Supply 0— 400 ampere @$35
New Feeders/Cirwits ( ) @ $6 Each
— More Than 30
tsUoto200Ai
Detached Garage or Other Associated Structure
New SeMce/Power Supply � ��mpere @ $35
�
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Fe�iers/Circuits ( i� ) @ $2 E � .
Other (Specify) O�er (Specify
�� I G'+� ._
Total (the fee-calculated above or $35 multipli� Total (the fee calculated above or $35 m plied
by the number of required inspection trips, by the number of required inspection trips, `� ��,
whichever is greater) whichever is greater) �� �(�'
Requ�ts for ElectHcal InspecUon (REI) with a f� of $250 or I�s expire 12 months from the flll� date. The coMractor must have the work completed within
the 12 month period or submtt another REI that includ� the inspection fee for the uncomplet� work. Ir�pectlon fe� do not carry over from o� REI to
another.
A servlce charge of $30 will be added for all dishonored checks.
1 hereby certlfy that I Inspected the electrical InstallaUon herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
Final Inspection C�,,=-=���
This material can be made avallable In different foi
TDD (651) 297d198.
REI 02 (8/07)
Date
�-�� ��
such as lars�e orin
REC'p MAY 2 2 2008
� � ��� @ ����
, f; �.
Brallle or on a tape. To request, call 1-800-342-53:
Voice or