P - 75467Minnesota Departm nt of Labor and Industry
443 Lafayette Ro orth
St. Paul, MN 5 5-4342
Phone: (651 5064
TTY/MRS: 1) 297-4198
www.el city.state.mn.us
Co ractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
9/24/08 Contractor Must Schedule All Rou h-In
Address of Inspection — Street
6412 ASHTON AVE
Owner Name
Owner Telephone Number(s) — Include Area Code(s)
(763) 571-7306
tion — One Famil Dwellin /Associated Structur�
Yes Single Inspection Other Than Rough-In: � Ready Now
;ctions Contractor Must Schedule All Final Ins ctions �Will Schedule
CitylTownship County
FRIDLEY 4' ANOKA —
Project Description
• s
ADDED BATH GFI CIRCUIT
Contractor Name Contractor Mailing Address
EXCEL ELECTRIC LLC OF MN 6041 189TH LANE NW ANOKA, MN
Contractor Telephone Number Contractor E-mail Address
(763) 286-4232 gei�wiredexcel@msn.com
N
ConVactor Authorized Signature Contractor License Number
1 � ,� �CA02178
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @: $35
New Dwellin� Service/Power Supply 401 — 800 ampere @$60 _
New Dwelling Feeders/Circuits
Up to 30 Feeders/Circuits - $100
— More than 30 Feeders/Circuits (in addition to
1 Feeders/Circuits Ua To 200 A Ca� $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
Other (Specify)
0 — 400 ampere @ $35
( ) @ $6 Each
Electrical Utility
�ONNEXUS
Job/Project Contact Person
DEVERN MATSON
Existing Home/Structure Remodel or Addition
New 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
( 1 Feeders/Circuits Uo to 200 A[o� $6 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
TOt11(the fee calculated above or $35 multiplied TOtal (the fee calculated above or $35 multiplied �S 7i
by the number of required inspection trips, by the number of required inspection trips, �
whichever is greater) whichever is greater)
Requests for Electrlcal Inspectlon (REI) wlth a fee of $260 or less explre 12 months from the flling date. The contractor must have the work completed wlthln
the 72 month peHod or submlt another REI that Includes the Inspectlon fee for the uncomple�d work. Inspectlon fees do not carry ov�r from one REI to
another.
A servlce charge of $30 wlll be added for all dlshonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated:
Rough — In Inspection(s) , Date
Final Inspection Date
,>?�-=��° ( _ . � �
This mate can be made avallable i�, ni , a print
TDD (651) 297-4198. /� ; � ���'•� �—���
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REC'D S E P 2' 9 2008
or on a tape. To request, call 7-800-342-5354 (DIAL-DLp Volce or