P - 75536Minr►esoia Departrnent oi Labor and Industry
° 443 Lafayette Road �,
St Paul, MN 551 2
phone: (651) 5064
TTY/MRS: 1) 297-4198
www.ele .state.mn.us
Con ctor Re uest for Electrical
Date Rough-In Inspection Required?
5/13/2008 Contrac�or Must Schedule AII Rou�
tion — One Famil D�vellin /Associated Structure
Yes Singte Inspection Other Than Rough-In; � Ready Ido�ro
�iw�s Contrac�or M� S�hedule All Final In.saections n V�ill Schedule
6291 CAROL DRIVE _ p+'1 R'�" - � FRIDLEY ANOKA
Owner Name � ��� � Projeat D�cription
CHARLES 8 KISHA DELAIN ' BASEMENT FIIdISH - FAMILY ROOM, BATH, AND
Owner Telephone Numbsr(s) — Indude Area Code(s) BEDROOM
(763) 572-5071
Contrador Name Cor�tr°�ac�or Mailing Address
VISTA ELECTRIC, INC. Ce � j PO BOX 524 ROCKFORD, MN 55373
Contracbor Telephone Number Contrac4or E�naa Address Electrical Utility
(763) 477-Q010 61� 7�/-03 vishaetectricmn@yahao.com
C ctor Authoriz d Signat�ue Contrador Licen� N�unber Job/Projed Cor�et Person
CA02321 DAVE BERG
Fee Ca1culation
Nerov Home or AssociaUed Struct�ure
Near Dwelling Service/Power SupAly 0— 400 ampere �$35
New Dwelling Service/Power SupPty 401 — 800 art►pere �$f�
New Dwellfia FeedersJCircuits
To
Detach� Garage or Other Associabed Struct�re
New Servlce/Powrer Supply 0— 400 am�re ��iS
Newr Feeders/Circuits ( ) � $6 Each
Other {Specii�+)
Existing Hom�Structure Rernodel or Addition
Nsw Senrice/Power SuW�JY 0— 4� ampere � S35
Neav Senriae/Power SuPPIy 401 — 800 ampere �$�
New/Extended Fe�ersiCircufts — Up to 75 FeedersiCircuits
�-- Fi - _ $ss €asn-� a �ta 30� sa�a
r-eeaers�c�s -
m
�tached Garage or Ot#�er Associab� Structure
New �rv[ce/Power Supply 0— 4� ampere �$;i5
New/Extend� Feeders/Circuits ( ) @ $6 Each
Reconneded FeedersJCiraits ( ) � $2 Each
Other (S�)
$36
Total (the fee calculated above or $35 mumplied To�) (tlie tee cakxdated above or $35 mu�ipfred
by the number of requfred inspe�ion trips, by the rtumber of required "msp�ion Uips, %��� D
whidiever is greater) whid�ever es greate� I
Requests for �ectrlcal Inspectlon (REI) a� a fee a� � or I�s explre 12 motRhs from tl�e ftli� date.l'he carRrador must heve the work completed within
the 92 morith perlod w subm(t arroUter REI that Includes the tr�an fee Tor the �mccrrtp[eted warEc. l�peetlon i�s do nat carry mrer irom one REI to
artaR)ter.
d service charge ��i0 wiU be �ded tor atl �6shonored checics
I hereby cert�yt tF►et I
Rough — In Inspe
Tn�s mater�a� �an �maae
T�D (851) 287-4198.
REI 02 (6/0�
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torrt�s. such � lerge print, Braille or on
For Departrne�R Use Only
�6� � Ce �
MAY 19 2008
To r�u�t ca11 1.SQO�d2��e
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