P - 76923C�Q� lo
Minnesota Depa ent of Labor and Industry
443 Lafayette d North
St. Paul, MN 155-4342 �
Phone: (65 84-5064
TTY/MRS: 51) 297-4198
www.elec ity.state.mn.us
Contractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
10/25/2007 Contractor Must Schedule All Rou h-In
Address of Inspection - Street
6433 ABLE ST NE
Owner Name
MERLIN GUNDERSON
Owner Telephone Number(s) - Include Area Code(s)
(763) 571-6782
� �`��?l��
R�C'D OCT 2: 9 2007
tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: � Ready Now
�ctions Contractor Must Schedule All Final Ins ections ✓❑ Will Schedule
City/Township County
FRIDLEY ANOKA
WIRE/ RECONNECT FURNACE AND AIR
CONDITIONER
Contractor Name Contractor Mailing Address
CENTERPOINT ENERGY 9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(763) 757-62U2 joann.zinken@CenterPointEnergy
Contractor Authorized Signature Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
Up to 30 Feeders/Circuits - $100
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)
0 — 400 ampere @ $35
( j a� $6 Each
Existing Home/Structure Remodel or Addition
New Service/Power Supply
New Service/Power Supply
New/Exiended Fee��TS1Cir�uits
( ) Feeders/Circuits @ $
New/F�ctended Feeders/Circuits —
( ) Feeders/Circuits
Reconnected Feeders/Circuits
0 — 400 ampere @ $35
401 — 800 ampere @ $60
— �p w io reaue�si�.ncun:
6 Each or 16 to 30 CcD $100
to 200 A
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
$4
Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, � 3.5��
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of E250 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���rOmUleted work. Inspection fees do not carry over from one REI to
another. �'
A service charge of E30 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates
Rough — In Inspection(s) Date
This material can b�
TDD (651) 297-4198.
REI 02 (6/07)
Date
_ ,�y^ �%
ich as Iar�e o
or on a tape. i o request, call 1-500-34Z-5354
�
:e or