P - 75582Minnesota De
443 Lafayette
St. Paul, MN
Phone: (651)
TTY/MRS: (6
3nt of Labor and Industry
North
297-4198
Contrac�or Re uest for Electrical I
Date Rough-In Inspection Required?
8/22/08 Contractor Must Schedule All Rou I
Address of Inspection — Street
7541 ABLE ST NE
HARRY VERNER
Owner Telephone Number(s) — I
(763) 413-8192
Contractor Name
DYMANYK ELECTRIC
Contractor Telephone Number
(612) 379-4112
Contractor Authorized Signature
:tion — One Famil � Dwellin
Yes Single Inspection Other Than
City/Township County
FRIDLEY ANOKA
Project Descriptlon
WIRE OUTLET FOR SUMP PUMP
Contractor Mailing Address
1915 NE BROADWAY
eldon@dymanykelectric.com
Contractor License Number
CA00554
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
fVew Gweiting FeederslCircufts -
r rovurn�vncu�w - y
cuits (in addition to
To 200 A (�a. $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
ElecVical Utllity
KCEL
Job/Project Contact Person
ELDON HOLMES
Structure
� Ready Now
� Will Schedule
Exlsting HomelStructure Remodel or Addltion
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401— 800 ampere @$60
IVewiExtended Fe�ders/eircuits — Up to 15 Feeders/Gircvits I
( 1 ) Feeders/Circuits aCi $6 Each or 16 to 30 @$100
New/Eutended Feeders/Cfrcuits — Mere Than 30 Fwwdwrc/Cirndtc
to 200 A Ca� $6 Each
( ) Feeders/Circuits @,i $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
Other (Soecifii)
�
Totel (the fee calculated above or $35 multlplied Totel (the fee calculated above or $35 mul�plied
by the number of required inspection trips, by the number of required inspecUon Mps,
whichever is greater) whichever is greater) $35 •�
Requests tor ElecMcel Inspecdon (REI) with a fee of $250 or less �xpire 12 months irom the flling dat�. The contractor must heve the work completed wfthl�,
the 12 moMh peHod or submlt another REI thet includes the inspectlon tee for the uncompleted work. Inspection fees do not c�rry over from one REI to '� ��
another. • �,?� �
��� �, y� Z_,� � A service charge ot $30 will be added for all diahonored checka.
I hereby certfiy that I inspected the electrical installatlon herein on the dates stated: G For Depardnent Use Only
Rough — In Inspection(s) Date
This matenal can be made
TDD (651) 297-4198.
REI 02 (6/07)
� � � `� �.� /�I �
Date
� -rr - ��' REC'D AUG 2'� 200�
�uch as large print, Braille or o a tape. To request, call 1-800-342-535
or