P - 75558Minnesota De nt of Labor and Indushy
443 Lafaye4te � d North
St� Paul, MN 5155-4342
Phone: ( 284-5064
TfYMIRS� 651) 297-4198
www.el c�ty.state.mn.us
Contractor R uest for Electrical
� Rough-In Inspe�tion Required?
&11-08 ����r Must Schedule AII Rou
Address of Inspec�on — Str�t
5543 E. BAVARIAN PASS
Owner Name
JOAN WOLF
— Inc�ude Area
(763) 502-0350
Ye,s
���
— One
� �
Structure
Ready Now
] Will Schedule
Ciiylfownship Courrty
FRIDLEY ANOKA
Projed De.scription
INSTALL CEILING FAN, TRACK LIGHTING IN UPPER
LOFT AREA �j � to t�,. h�, Ovn �
��—=
PRIMARY ELECTRIC, IMC. � 9167 LANEWOOD LANE NORTH, MAPLE GROVE, MW 55369
ctor 1 elephone Number
213-6262
�
CA04911
Fee Calculation
New Home or Associat� Strudure
Mew D�ning se►vioelPower supp�y o— 40o ampere (� S35
Idew nweuing servioe/Power supply 401 — 80o am�re �$�
0
Yl.1�`7i�rU W16^i �
(in addi�on to
Detach� Garage or Other Assoctat�l Structur�e
Plew Senrioe/Paa+er SuPP�r �— 4� ampere a�D $35
New FeederslCircuits ( ) @ gg �
(S�)
�onirro�ecx c:onta�t Person
CHRIS B. BOETTCHER
Existing Home/Strucburoe Remodel or Addttion
New ServiaelPoarer Supply 0— 4� ampere @$35
New Senrioe/Power SuPP�Y 401 — 800 ampere �$60
New/FYfand�l Faarlo,rc/�`im� �ifa _ I In f.. a� Cm.iennrri.... �:te
7�eederslCvc�i� $6 Ead� or 16 to 30
Iew/E�dended Feede�afCir�a�its — More Than 30 Feed
Eei�l
( FcedersJCirc�its _ S2 Eadi I
De�ached Garage or Other Associa�ed Sbvcture
New Senric�/Po�er SuRP�Y �— 4� amper+e aLD $35
MewlF�Re�Med FeederaJCircuifs ( ) G � Eac�
R�nneded Fesders/Circuiffi ( ) Ca3 $2 Each
TWO INSPECTIONS
Total (tl�e fee calcarlated a�ve or $35 multiptiad Tot81(the f� calculab� above or $35 multiplied
by the number of required inspectian trips, by the number of r�uired inspe�ion trips,
whichever is greabe� whichever is greate� $7'�
Requests for Deetrical lnspedion (REI) wtl1� a tee oi S260 w less e:p)re 12 montl� from the fliing date. The contractor must have tlre �ic completed wit�ln ��
the 12 mar►U� period or submit anofher REI that fnctud� tlte Ir�spedlon fee for iha u�ompleted work. lnspectlon fe� do rrot carry over irom one REI�
arrother. (�,
A�rvlee cl�rge of S i0 wt1l be added for all dlshonor�d Chec�cs. g] �>
b
� t�r oe►tifY that i insp�ed tl�e etectrical 6�[la6on h�ein an Ure da6es stated: F. Depardnent Use Onip
Rough — In Inspedion(s) Date � � � (;- •-- GO $� � C1%� `� `
�S�-�z_��r �� ��'�' �" � � Z�'
Fnallns�on �� �� RE�'p AUG 19 2008
Th� material can be rrmde avallab� In dH(e�rn tom�s, such � la�ge pdM, B e or on a tape. To r�quest, ca111�00,942-b364 (DIAL-DLq Volee or
TDD (881) �7�198.
REI 02 (610�