P - 75549:
�
Minnesota Department of Labor and Industry
443 Lafayette Road North
St. Paul, MN�!�5155-4342
Phone: (6„ 284-5064
TTY/MR . (651) 297-4198
www.el ricity.state.mn.us
C tractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
8�8�08 Contractor Must Schedule All Rou h-In
Address of Inspection — Street
,6250 7TH STREET
Owner Name
SANDY MOSES
Owner Telephone Number(s) - Include Area Code(s)
(763) 571-5808
SOUTH SIDE ELECTRIC INC
888-5500
gnature
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�.� - �l� L� �/
tion — One Famil Dwellin /Associated Structure
Yes Single Inspection OtherThan Rough-In: Q Ready Now
�ctions Contractor Must Schedule All Final Ins ections ✓� Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description
REPLACE 100 AMP MAST RISER,
RISER INSTALLED BY OTHERS �
9201 E BLOOMINGTON FRWY #X, BLOOMINGTON MN 55420
CAO 1695
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
Fee Calculation
New Dwelling Service/Power Supply 401 — 800 ampere @$60
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 Feeders/Circuits
Other (Specify)
Other
0 — 400 ampere @ $35
( ) @ $6 Each
AL JOHNSON 952-292-8400
Existing Home/Structure Remodel or Addition
Plew Service/Power Supply � 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits
( ) Feeders/Circuits @$6 Each or 16 to 30 @$100
New/Extended Feeders/Circuits — More Than 30 Feeders/Circuits
( ) Feeders/Circuits Up to 200 A@$6 Each
Reconnected Feeders/Circuits
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
Other (Specify)
TOtal (the fee calculated above or $35 multiplied TOtel (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, �✓tJ. ,,
whichever is greater) whichever is greater) ✓' �
Requests for Electrlcal Inspectlon (REI) wfth a fee of $250 or less explre 12 months from the flling date. The corrtractor must have the work completed within
the 12 month peNod or submtt another REI that Includes the Inspectfon fee for the uncompleted work. Inspectlon fees do not car►y over from one REI to
another. �
A servlce charge of $30 wlll be added for all dlshonored checks. �
Rough — In Inspection(s)
This mate�lal can be made available in
TDD (651) 297-4198.
REI 02 (6/07)
on the dates stated:
Date
� For oepa t use only
"� C'D AU 3 2008
Date � � � a ��
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ms, such as large print, Brallle or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or