P - 76965Minnesota Dep ment of Labor and Industry
443 Lafayette oad North
St. Paul, MN 5155-4342
Phone: (65 284-5064
TTY/MRS: 51) 297-4198
www.electr ty.state.mn.us
Contr tor Re uest for Electrical Ins
Date Rough-In Inspection Required?
8/30 Contractor Must Schedule All Rou h-In
Address of Inspection — Street
7436 CONCERTO CURVE NE
Owner Name
DARRELL RITZEMA
Owner Telephone Number(s) - Include Area Code(s)
(763) 780-8401
Contractor Name
CENTERPOINT ENERGY
Contractor Telephone
(763) 7� 2
Signature
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tion — One Famil Dwellin /Associated Structure :
Yes Single Inspection Other Than Rough-In: � Ready Now
:ctions Contractor Must Schedule All Final Inspections ✓0 Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description
WIRE/ RECONNECT AIR CONDITIONER
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utility
jcanr.zi�ken rGJCentcrPointErergy
Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
New Home or Associated Structure
Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0— 400 ampere @$35 I I New Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
- - Fi� Dwelling Feeders/Circuits -
Up to 30 Feeders/Circuits - $
New Home — More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A@$6 Each
Other (Specify)
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
hiew FeedersiCircuits ( ) @ $6 Eacn
(Specify)
pecify)
New Service/Power Supply
401 — 800 ampere @ $60
:s — Up to 15 FeerJers/Circuits
$6 Each or 16 to 30 @$100
— More Than 30 Feeders/Circui
Feeders/Circuits U to 200 A $6 Each
Reconnected Feeders/Circuits
1 Feeders/Circuits $2 Each $2
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
NewiExtended reederslCircuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Specify)
Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied s(`j
by the number of required inspection trips, by the number of required inspection trips, �D/
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of 5250 or less expire 12 months from the filing date. The contrector must have the work completed within
the 72 month period or submit another REI that includes the inspection fee for the uncompleted work. Inspection fees do not carry over from one REI to
another.
A service charge of E30 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
Finallnspection . �at?
C..''��t_ � �j l
This material can be made available in different forms, such a§ large
TDD (651) 297-4798.
REI 02 (6/07)
or on a tape.
or