P - 75550Minnesota Department of Labor and Industry
443 LafayettE'R d North
St. P�ul, MN 5 55-4342
Phone: (651) 5064
TTY/MRS: ( 1) 297-4198
www.electri .state.mn.us
Contr ctor Request for Electrical Ins
Date Rough-In Inspection Required?
3/1/08 Contractor Must Schedule All Rou h-In
Address of Inspection — Str�et
6412 ASHTON AVE �
Owner Name
REDEEMERLUTHERN
Owner Telephone Numbe�(s) — Include Area Code(s)
(763) 571-7306
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 gefinriredexcel@msn.com
Contractor Authorized Signature Contractor License Number
, CA02178
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
Project Description •
NEW SUBPANEL .
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
Home — More than 30
(Specify)
Up to 30 F�
Feeders/Circui
ICircuits Up To
s/Gircuits - $100
addition to
� @ $6 Each
Detached Garage or Other Associated Structure
New Service/Power Suppl��
New Feeders/Circuits
Other (Specifir)
0 — 4ci0 ampere @ $35
( ) @ $6 Each
�
Electrical Utility
�ONNEXUS ENERGY
Job/Project Contact Person
DEVERN MATSON
Existing Home/Structure Remodel or Addit�on
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
New/Extended FeederslCircuits — 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 U to 200 A $6 Each
Reconnected Feeders/Circuits ;
' � 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
TOtal (the fee calculated above or $35 multiplied TO'tel (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips,
whichever is greater) whichever is greater) $35
Requests for Electrtcal Inspectlon (REI) wlth a fee of $250 or less explre 12 months from the flling date. The contractor must have the work completed wlthln
the 12 month peMod or submlt another REI that includes the Inspectlon fee for the uncompleted work. Inspectfon fees do not carry over from one REI to
'�'' another.
�A servlce charge of $30 will be added for all dlshonored checks.
I hereby certify that I inspected the elecfical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date � � -
;��,�C�
FinallnspJ�j' ion � _ bate a.
� ��- �/ ° � �l.✓`"°�''_ �.J r -� .�� U
This riPaterial can be made available in different forms, such as large �
TDD (651) 297-4198.
o�� n� icin��
REC'� �� n 4 2008
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or on a rape. To requ.,�t, call
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