P - 75465Minnesota Depar
443 Lafayette Ro
St. Paul, MN 551
Phone: (651) 2&,
TTY/MRS: (651,�
www.electricity.�
of Labor and Industry
-4198
Contractb�r Re uest for Electrical I
Date Rough-In Inspection Required?
9/25/08 Contraetor Must Schedule All Rou I
Address of Inspection — Street
5503 EAST BAVARIAN PASS
Owner Name
MARY WRIGHT
Owner Telephone Number(s) — Include Area Code(s)
(763) 571-4377
tion — One Famil Dwellin /Associ
Yes Single Inspection Other Than Rough-In:
:ctions Contractor Must Schedule All Final Ins ecti
CitylTownship County
FRIDLEY ANOKA
Project Description
FIX BROKEN RECEPTACLE
Contractor Name Contractor Mailing Address
CARTER ELECTRIC INC 105 TALMADGE WAY NE FRIDLEY MN 55432
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(763) 486-7616 carter.electric@hotmail.com XCEL
Contractor Authorized Signature Contractor License Number Job/Project Cor
CA04848 BRANDON
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
up t� �u rccuaia,.,u�una - a
New Home — More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A@$6 Each
Other (Specifir)
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
Other (Specify)
Other
0 — 400 ampere @ $35
( ) @ $6 Each
Person
Structure
] Ready Now
1 Will schedule
F�cisting Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits
( ) Feeders/Circuits @$6 Each or 16 to 30 @$100
New/Extended Feeders/Circuits — More Than 30 Feeders/Circuits
f ) Feeders/Circuits Up to 200 A Cu� $6 Each
( ) Feeders/Circuits @ $2 Each �
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Sqecifv)
TOtal (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, $35 �
whichever is greater) whichever is greater) �
Requests for Electrlcal Inspectlon (REI) wlth a fee of $250 or less explre 12 months from the flling date. The coritraactor must have the work compteted wlthlA� �
the 12 month perlod or submtt another REI that Includes the lnspecUon fee for the uncompleted work. Inspectlon fees do not carry over from one REI to
another.
A servlce charge of $30 wlll be added for all dlshonored checks. ��
I hereby certify that I inspected the electrical installation herein on the dates stat�: For Departrtl8n Only
Rough — In Inspection(s) Date a���� ��j �
Final Inspectio � __ Date REC'D S E P 2 3 2008
Thls mate�l can be rgadfl availa4lQ In different forms, sudh as large print, Braille or on a Yape. To requ�t, call 1-800-342-53b4 (DIAL-DLq Volce or
TDD (651) 297-4198. '
REI 02 (6/07) . _ e._ .. -------
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