P - 75707Minnesota De ent of Labor and Industry
443 Lafayette d North
St. Paul, M 5155-4342
Phone: (6 284-5064
TTY/MR (651) 297-4198
www.el 'city.state.mn.us
Contractor/Re istered Em
Date Rough-In Inspection Required?
8�2��07 ContractodEm lo er Must Schedule All Rou h-Ir
Address of Inspection — Street
7450 CONCERTO CURVE NE
Owner Name
ROGER HALL
Owner Telephone Number(s) — Include Area Code(s)
(763) 786-4543
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�cro Au � 2 4 200�
rer Re uest for Electrical Ins ecti
Y� Single Inspection Other Than Rough-In:
�tions ContractodEm lo er Must Schedule All Final Ins
City/Township County
FRIDLEY ANOKA
Project Description
WIRE FOR FAN & REMOTE
ContractoNRegistered Employer Name Contractor/Registered Employer Mailing Address
COLLINS 278 STATE STREET ST PAUL MN 55107
Contractor/Employer Telephone Number Contractor/Employer E-mail Address Electrical Util'ity
(651) 224-2833
Number � Job/Project
Fee Calculation
Servic�/Power Supply 0— 400 ampere @$35 Technology System Devices (
Service/Power Supply 401 — 800 ampere @$60 Separate Bonding Inspections for Swimm
E ui tential Planes
Center Pivot Irrigation B�ms (
Service/Power Supply Above 800 ampere @$100
Plus Electrical Drive I
New/Extended Feeders/Circuits Up To 200 A( )@$6 Each Luminaire Retrofit Modifications (
Feeders/Circuits Above 200 A ( )@$15 Each Concrete-Encased Electrode Inspection (
Investigative Fee $70 Or The Total Inspe�
Reconnected Feeders/Circuits ( ) @ $2 Each
Whichever Is Greater U To $1,000
Manufactured Home Park Lot Supply ( )@$35 Each Special Inspectlon Fee ( ) Hours
Plus Miles The IRS Mil
Recreational Vehicle Site Supply Equipment Other
Ready Now
Will Schedule
) @ 75¢ Each
�g Pools and
) (� $35 Each
) @ $35 Each
nits $5 Each
) @ 25¢ Each
) @ $35 Each
ion Fee,
� $SO Per Hour
Circuits Ori inatln in the E uipment $6 Each
Street, Parking l.ot, Lightlng Standard ( )@$5 Each Over 600 Volts — ndd are com�ed serv�ce��ersuvNr ��� ��
result in doubte the regular fee (does rrot apply ro electric sign and �tAne tlghtlng)
Transformers Up to 10 kva ( )@$15 Each � ) New MuIU-Family Dwellings @$70 Each
With Up To 20 Feeders/Circuits
Transformers Over 10 kva ( )@$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
6 Each
Electric Signs and OuUine Lightlng Totel (the fee plculated above or $35 multiplied �
Transformers/Power Su lies $5 Each by the number of required inspection Mps, �
whichever is greater)
Requests forElectrical Inspection (REI) with a fee of $250 or less expire 12 months from the flting date. The contractor/employer must have the work
completed within the 12 month period or submit another REI that Includes the inspectlon fee for the uncompleted work. Inspeetion fe� do not earry over
from one REI to another.
A service char e of $30 will be added for all dishonored checks.
I hereby certify that I inspeded the electrical installatlon herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
This material can be made avaflal
TDD (651) 297-4198. ,y N
REI 03 (6/07)
Date
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such as large print, Braille or on a tape. To
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