P - 75377Minnesota Departrnent of Labor and Industry
• 443 L'afayette Road North
St. Paul, MN 5515 342
Phone: (651) ` 5064 � � bq'�
TTY/MRS: ( 297-4198 � �
www.ele ' ' .state.mn.us
Con ctor Re uest for Electrical I
Date Rough-In Inspection Required?
10/27/2008 Contractor Must Schedule All Rou I
Address of Inspection - Street ">
6426 BAKER AVE NE
STEPHEN BOGGS `
Owner Telephone Number(s) -:
(763) 571-4952
Contractor Name
CENTERPOINT ENERGY
(763) 757-6202
Contractor Authorized Signature
Yes
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— One Famil Dwellin /Associated Structure
Single Inspection Other Than Rough-In: � Ready Now
Contractor Must Schedule All Final Ins ections ✓❑ Will Schedule
City/Township County
FRIDLEY ANOKA
Drnicr4 Ilccrrinhinn
WIRE/ RECONNECT FURNACE AND AIR
CONDITIONER
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utility
Contractor License Number
CA01796
Fee Calculation
N ome or Associated Structure
New Dwelling Service/Power Supply 0- @$35
New Dwelling Service/Power Supply 401 - 800 ampere @> $60
Job/Project Contact Person
JOANN ZINKEN
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
U to 30 Feeders/Circuits -$100 Feeders/Circuits $6 Each or 16 to 30 $100
New Home – More than 30 Feeders/Circuits (in addition to New/Extended Feeders/Circuits – More Than 30 Feeders/Circuits
above Feeders/Circuits U To 200 A $6 Each Feeders/Circuits U to 200 A $6 Each
Other (Specify) ; Reconnected Feeders/Circuits
2 Feeders/Circuits $2 Each $4
Detached Garage or Other Associated Structure Detached Garage or Other Associated Structure
New Service/Power Supply 0– 400 ampere @$35 New Service/Power Supply 0– 400 ampere @$35
New Feeders/Circuits � ( ) @ $6 Each New/Extended Feeders/Circuits ( ) @ $6 Each
Other (Specify)
Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Specify) Other (Specify) v � /�
,� _ �.J
TOtal (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied d
by the number of required inspection trips, by the number of required inspection trips, �,,�5 �$
whichever is greater) whichever is greater)
Requests for Electrical Inspection�(REI) wkh a fee of $250 or less expire 12 months from the filing date. The contractor must have the work completed within
the 12 month perfod or submk another REI that includes the InspecUon fee for the uncompleted work. InspecUon fees do not carry over from one REI to
another.
� A servlce charge of $30 will be added for all dlshonored checks.
I herebvi certifir that I ins�ded the electrical installation herein on the dates stated: For Department Use Only
Rough - In Inspection(s)
Final Inspectio
�
This materia can bi
TDD (651) 297�198.
REI 02 (6/0�
Date
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' Date
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R��D OCT 2 9 2008
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