P - 76739Minnesota Dep ment of Labor and Industry
443 Lafayette ad North .. �
St. Paul, M 5155-4342
Phone: (6 284-5064
TTY/MR (651) 297-4198
www.el ricity.state.mn.us
Co ractor Re uest for Electrical Ins
Date Rough-In Inspection Required? [
2-18-08 Contractor Must Schedule All Rou h-In Ir
Address of Inspection — Street
6801 CHANNEL ROAD
Owner Name
JIM GILBERTSON
Owner Telephone Number(s) — Include Area Code(s)
(612) 581-6655
tion - One Famil Dweilin /Associated Structure
Yes Single Inspection Other Than Rough-In: � Ready Now
�ctions Contractor Must Schedule All Final Ins ections ✓❑ Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description
JTN23729-R REPLACE SERVICE MAST
Contractor Name Contractor Mailing Address
MUSKA ELECTRIC COMPANY 1985 OAKCREST AVEUE, ROSEVILLE, MN 55113
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(651) 636-5820
Contractor License Number
CA01287
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
Fee�ersiCircuits
Home — More than 30
Other (Specify)
to 30 Feeders/Circuits - $100
s/Circuits (in addition to
� Up To 200 A CcD $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
0 — 400 ampere @ $35
( ) @ $6 Each
TOt81 (the fee calculated above or $35 multiplied
by the number of required inspection trips,
whichever is greater)
Job/Project Contact Person
KEITH PETERSON
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
NewiE�ended reeders/Gircuits — Up to 15 Feeders/Circuits
( ) Feeders/Circuits CD_ $6 Each or 16 to 30 Ca� $100
Feeders/Circuits — More Than 30 FeederslCi
► Feeders/Circuits Up to 200 A CD_ $6 Each
Reconnected
( ) Feeders/Circuits $2 Each �
Detached Garage or Other Associated Structure
New Service/Power Supply
New/Extended Feeders/Circuits (
0 — 400 ampere @ $35
) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Total (the fee calculated above or $35 multiplied
by the number of required inspection trips,
whichever is greater)
$35
$35
Requests for Electrical lnspection (REI) with a fee of 5250 or less expire 12 months from the filing date. The contrector must have the work completed within
the 12 month period or submit another REI that includes the inspection fee for the uncompleted work. lnspection fees do not carry over from one REI to
another.
A service charge of 530 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date , �
Final Inspection Date
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This materlal can be made available in different forms, such as large prti
TDD (651) 297-4198.
REI 02 (6/07)
c�--�,`'1� U — W c.�-=� `
REC'D F'�" 21 fi�08
or on a tape. 70
(DIAL-DLI) Voice or