P - 75659Minnesota Departrnerrt of Labor and Industry
443 Lafayette Road North
St. Paul, MN 55` 55-4342
Phone: (651) � 5064
TTY/MRS: ( ) 297-4198
www.electri .state.mn.us
Con ctor Re uest for Electrical Ins
Date Rough-In Inspection Required?
7/5/08 Contractor Must Schedule All Rou h-In
Address of Inspec6on — Street
151 79TH WAY N.E.
JANET CHISHOLM
Ovmer Telephone NumbeKs) —
(612) 202-6505
Contractor Name
RENER ELECTRIC, INC.
433-0569 •
Yes
— One
Contractor Must Schedule All Final
FRIDLEY � ANOKA
Project Description
ADD SUB PANEL @ WIRE NEW AC UNIT
6113 114TH PL. NO. CHAMPLIN, MN. 55316
Contractor E-mail Address Elechical Utility
Contractor Li�nse Number Job/Project Contact Person
CA02272 JANET
� �
Fee Calculation (����"�?���
New Home or Associated Structure
New Dwelling Servic�/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
to
A
s_
to
Detached Garage or Other Assoclated Structure
New Service/Power Supply 0— 400 ampere @$35
New FeedersJCircuits ( ) @ $6 Each
Other (SpecifY)
Structuce
Ready Now
� Will Schedule
Exlsting Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere �$35
New Servi�/Power Supply 401 — 800 ampere @$60
New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits
�(' Feeders/C��uiis $6 Eac� or 16 to 30 $100
NRw�xtended Feeders/Circuits — More Than 30 Feeder�Circuits
Detached Garage or Other Assoclated Structure
New Service/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconneded FeedersJCircuits ( ) @ $2 Each
Other (Specify)
TOt81(the fee calculat� above or $35 multiplied TOtal (the fee calculated above or $35 multiplied
by the number of requir� inspedion trips, by the number of required inspedion Uips, $36
whichever is greater) whichever is greater)
Requeats ior Electrlcal I�pecUon (REI) with a i� oi 5260 or I�s expire 72 months irom the flling date. The contrador must have the work completed within
the 1 Z mor�th perlod or submR anolher REI that includ� the Inspectlon fee for the uncompleted work. Inspecdon fe� do not carry over irom one REI to
another.
q service charge of S30 wlll be added for all dlshonored checks.
I hereby certify that I inspeded the electrical installadon herein on the dat� stated: For Departme�rt Use Only
Rough — In Inspedion(s) Date r a� 9�ri�
�� � L« �
Final Inspection � Date ^, ��p J U L � 2000
7 - ��_�
Thls materlal can be e available In diftererK forrr�, such as large pri Braille or on a tape. To requ�t, cell 1�00-342-5364 (DIAL-Dl.� Volce or
TDD (651) 287.4188.
REI 02 (6/0�