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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 ����� G� 1 � �� 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 fVtlW rtl6UC1A"lGIfGUIlS Other (Specify) Other (Specify) � � lw .pv caa � New Service/Power Supply New Service/Power Supply wvc�.rovnw�w - 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� �c� � `-��--- � Fidal I This material can be made available in TDD (651) 297-4198. REI 02 (6/07) Date ��.G Date ' � G s h as large print, Braille or on a 0 request, call 1 or