P - 76891Minnesota Depa nt of Labor and Industry
443 Lafayette R North
St. Paul, MN 55-4342 �
Phone: (651 -5064
TTY/MRS: 1) 297-4198 ,/�/'
www.elect ty.state.mn.us
Contractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
9-21-07 Contractor Must Schedule All Rou h-In
Address of Inspection - Street
5330 7TH STREET NE
Owner Name
DEANJOHNSON
Owner Telephone Number(s) - Include Area Code(s)
(753) 742-3621 (763) 572-0527
����- �I���f
REC'D ��' P 2 4 2001
tion - One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: � Ready Now
:ctions Contractor Must Schedule All Final Inspections ✓� Will Schedule
FRIDLEY � ANOKA
Project Description
C22125-R INSTALL SERVICE AND ADD POWER TO
GARAGE AND SET SUBPANEL
Contractor Name Contractor Mailing Address
MUSKA ELECTRIC COMPANY 1985 OAKCREST AVEUE, ROSEVILLE, MN 55113
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(651) 639-5130 EXCEL
Cont�u��ized Sig{�atu Contractor License Number Job/Project Contact Person
��� ��, A01287 KEITH PETERSON
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 Supply1,.� 0– 400 ampere @ 35 �-"�
New Dwelling Service/Power Supply 401 – 800 ampere @$60 New Service/Power Supply 401 – 800 ampere @$60
ne�v �we!!i�g Fe?�ers/Circuits - -- — Ne���p� Si -' 1^• • �� l�a.,t+:F�o,�o��ir�r��i �
� �0 4 a-• �
U to 30 Feeders/Circuits -$100 � ed ICircuits $6 Each or 16 to 30 $100
New Home – More than 30 Feeders/Circuits (in addition to New/Extended FeederslCircuits – More Than 30 Feeders/Circuits
above Feeders/Circuits U To 200 A $6 Each / Feeders/Circuits U to 200 A $6 Each
fl4hnr /Cnnrifv\ Reconnected Feeders/Circuits
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
Other (Specify)
(Specify)
0 – 400 ampere @ $35
( ) @ $6 Each
( ) Feeders/Circuits @ $2 Each �
Detached Garage or Other Associated Structure
New Service/Power Supply 0– 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
TOt81 (the fee calculated above or $35 multiplied TOtal (the fee calculats� above or �35 multiplied
by the number of required inspection trips, by the number of required inspection trips, � ���
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of 5250 or less expire 12 months from the filing date. The contractor must have the work completed wkhin
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 S30 will be added for all dishonored checks.
I hereby certiTy that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough - In Inspection(s)
Final Inspection
..
Thls mateNal can be
TDD (651) 297-4198.
REI 02 (6/07)
forms,
Date
Date
- �Y� 6
CFP 2 1 2007 �j �
i�i�
print, Braille or on a tape. To request, cau �
(DIAL-OLI) Voice or