P - 75388Minnesota De
443 Lafayette
St. Paul, MN
Phone: (651)
TTY/MRS: .
www.ele '
COtlt C
Date
9/4/08
;nt of Labor and Industry
North
) 297�198
>tate.mn.us
�r Re uest for Electrical Ins
Rough-In Inspection Required?
115 CROWN RD
#ion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: ❑ Ready Now
�ctions Cnntractor Must Schedule All Final Ins ctions 0 Will Schedule
City/Township County
FRIDLEY ANOKA
TIMOTHY DOP�11N1 ADD RANGE OUTLET ON DEDICATED CIRCUIT
Owner Telephons Number(� - Include Area Code(s)
(651) 246-5855 (952) 932-2734
Contractor Name Contractor Mailing Address
SPRINTER ELECTRICAL SERVICES 2525 NEVADA AVE N SUITE 203, GOLDEN VALLEY, MN 55427-3642
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(763) 546-8060 info@sprinterelectric.com
Contrador Authorized Signature Contractor License Number Job/Project Contact Person
CA03969 STEVEN DOBBERSTEIN
Fee Calculation
New Home or Associated Structure F�cisting Home/Structure Remodel or Addition
New Dwelling Servic:e/Power Supply 0— 400 ampere @$35 New Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60 New Servic�/Power Supply 401 — 800 ampere @$60
— More than
Other
to 30
�ua� aivu w�w - .�
ts (in addition to
200 A C� $6 Each
Deiached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) (� $6 Each
1 ) Feeders/Circuits @ $
'Extended Feeders/Circuits —
� ) Feeders/Circuits
mnected Feeders/Circuits
16to30@$100
30 Feeders/Circx�
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Fesders/Circuits ( ) @ $2 Each
$6
State Surcharge �, �Q
Tot11(the f� calculated above or $35 multiplied TOt31(the fee calculated above or $35 multiplied
by the number of required inspedion trips, by the number of required inspedion trips, $35 v fl
whichever is greater) whichever is greater) i
Requ�ts for Electrical Ir�pectlon (REQ wtth a fee of $250 or I�s explre 12 mor�ths trom the flling date. The contractor must have tl�e work completed wlthln
the 12 moMh period or submft another REI thet Indud� the Inspectlon fee for the uncompteted work. InspecUon fe� do not carry over from o� REI to
another.
�/(� c� 2 Z_�, a� A servlce charge of $30 �NI be added for all dlshonored checks.
( 0
I hereby certify that I inspected the elecfiql installation herein on the dates stated: �� �or Departrne�Ws� O�ly
Rough — In Inspection(s) Date � u
Thts materlal can bs made
TDD (66?) 297�F198.
REI 02 (6J07)
Date
j�-2 S�oa
ICh 88 18�S1B pl
� I
REC'D S E P 12 2008
or on a tape.
requ�t, cau
Volce or
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