P - 75420Minnesota Department of Labor and Industry
443 Lafayette Rn�d North
St. Paul, MN ��i55-4342
Phone: (651�845064
TTY/MRS: 51) 297-4198
www.ele ity.state.mn.us
Co actor Re uest for Electrical
Date Rough-In Inspection Required?
10-22-08 Contractor Must Schedule All Rou
Address of Inspection — Street
1651 CAMELLOT LANE
KURT PITNEY
Owner Telephone Number(s) — Include Area
(763) 574-2130
Contractor Name
PAUL STAFFORD
Contractor Telephone Number
(952) 927-7194
s ection — One Famil Dwellin /Associated Structure
Yes Single inspection Other Than Rough-In: � Ready Now
n Ins ections Contractor Must Schedule All Final Inspections ✓❑ Will Schedule
FRIDLEY � HENNEPIN
Project Description
ADDING SWITCHES AND OUTLETS IN KITCHEN
Contractor Mailing Address
6225 CAMBRIDGE STREET
Contractor E-mail Address
jesse@paulstaffordi nc. com
Contractot Lisense 1Vumbe�— --
CA01713
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere cG'D $60
idew Dwelling Feeders/Circuits
Feeders/Circuits -
Each
Other
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feede�s/Circuits
Other
( ) @ $6 Each
Utility
JESSE ELLINGSON
Exlsting Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Senrice/Power Supply 401 — 800 ampere @$60
New/Extended feeders/Circuit� — Up 4015Feeders/�rcuits
$6 Each or 16 to 30 $100
— More Than 30 Feeders/Circu
ts Up to 200 A C� $6 Each
Reconnected Feeders/Circuits
( ) Feeders/Circuits $2 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New/F�ctended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Total (the fee calculated above or $35 multiplied Tot11(the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, $35
whichever is greater) whichever is greater)
Requests for Electrica I Inspectlon (REI) with a fee oi $250 or less expire 12 months f rom the flling date. The corrtractor must have the work completed within
the 12 morith period or submit another REI that includes the Inspection fee for the uneompleted work. Inspection fees do not carry over from one REI to
another.
A service charge oi $30 will be added for all dishonored chec ks.
I hereby certify that I(nspected the elecMcal installatlon herefn on the dates stated: F�. no.,s.....e.,. � �ee n..�.,
Rough — In Inspection(s)
Final
i ms matenai can di
TDD (Bb1) 297�d198.
REI 02 (8/07) .
Date ��� � ���
Date
/� � 6 REC'D OGT � 9 200�
such as large pHnt, e on a tape. To request, call 1-800;
or