P - 76956Minnesota Departme f Labor and Industry
443 Lafayette Roa orth
St. Paul, MN 551 342
Phone: (651) 2 064
TTY/MRS: (6 297-4198
www.electric' .state.mn.us
Contr tor Re uest for Electrical Ins
Date Rough-In Inspection Required?
7-24-07 Contractor Must Schedule All Rou h-In
Address of Inspection — Street
6800 Channel Road
Owner Nam f��.�c,(�.i � C� �' (�c�L�.
Owner Telephone Number(s) — Include Area Code(s)
REC'D J U L 3 0 2001
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tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: Ready Now
�ctions Cor�tractor Must Schedule All Final Inspections � Will Schedule
City/T
Project Description
Addition
County
Contractor Name Contractor Mailing Address
Lazer Electric 8164 Arthur St. NE S rin Lake Park NIlV 55432
Contractor Telephone Number Contractor E-mail Address Electrical Utility
?i;� !�i—J�i Lc1
Co r or Authorized Si re Contractor License Number Job/Project Contact Person
CA01110 Chuck Schwieters
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Dwelling Feeders/Circuits
ew home —
to 30 Feeders/Circuits - $100
FeederslCircuits Uo To 200 A(cr�. $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere (a� 335
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Other (Specify)
Other (Specify)
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New Service/Power Supply
New Service/Power Supply
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Feeders/Circuits
0 — 400 ampere (� $35
401 — 800 ampere @ $60
— Up to 15 Feeders/Circuits
Feeders/Circuits
Detached Garage or Other Assoctated Structure
New SenricslPower Supply 0— 400 ampere � s35
Tvewl=xtenaeu-ree�unisi�.uw�w 1 I �E+1 �v �au�
Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Specify)
Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by thi number of required inspection trips, $42 .50
whichever is greater) whichever is greater)
Requests for Electrical InspecUon (REI) with a fee of 5250 or less expire 12 months from the flling date. The contractor must have tha work completed wfthin
the 12 month period or submit another REI that Includes the inspection fee for tne uncompleted work. Inspection fees do not carry over from one REI to
another.
A service cfiarge of 530 will be added for all dishonored checks. '
I hereby certify that I inspected the electrical installation herein o� the dates stated: For Department Use Only
Rough — In Insp�
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This material can be made available in
TDD (651) 297-4198.
REI 02 (6/07)
Date
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Date
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s h as large print, Braille or on a
0
request, call 1
or