P - 75421Minnesota Department of Labor and Industry
443 Lafayette Road Nor#h � �
St. Paul, MN 55155,��42 ,_,ry
Phone: (651) 284-, p64 '� I 1 �''�
TfY/MRS: (651) 7-4198 �/
www.electricity. te.mn.us
Contract r Re uest for Electrical Ins
Date Rough-In Inspection Required?
10/24/2008 Contractor Must Schedule All Rou h-In
Address of Inspection - Street
8051 E�jP RIVER ROAD
Owner Name
STEVE GILLAN ,
Owner Telephone mber(s) - Incluc
(763) 784-9516 (�--�'
Contractor Name
CENTERPOINT ENERGY
(763) 757-6202
Authorized
����` ��'� �
tion — One Famil / Dwelli
Yes Single Inspection Other Tha
Contractor Must Schedule All Final Ins ecti
City/Township County
FRIDLEY ANOKA
Project Description
WIRE/ RECONNECT FURNACE
ated Structure
❑ Ready Now
ms n Will Schedule
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utility
joann.zinken@CenterPointEnergy
Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
w Home or Associated Structure
New Dwelling Service/Power Supp y ampere @$35
New Dwelling Service/Power Supply 401 - 800 ampere @$60
Ideew Dwetlingfeeders/Gircuits - —
Up to 30 Feeders/Circuits - $100
New Home - More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A@$6 Each
Other (Sneciiv) �
Detached Garaqe or Other Associated Structure
New Service/Power Supply 0- 400 ampere @$35
Nev✓ FeederslCircuits ( ) @ $6 Each
Other (Specify)
Other (Specifvl
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0- 400 ampere @$35
New Service/Power Supply 401 - 800 ampere @$60
Newl�i�en�edFe`ederc7(:i�ewf.c —T�n fn"iSFaar�aarc/[`imiii+c
Feeders/Circuits $6 Each or 16 to 30 $100
New/Extended Feeders/Circuits - More Than 30 Feeders/Circuits
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
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Total (the fee calculated abovevr $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, 3S .5�
whichever is greater) whichever is greater)
Requests for Electrlcal InspecUon� (REI) wkh a fee of $250 or less expire 12 months from the flling date. The contractor must have the work completed withln
the 72 month perlod or submft another REI that Includes the fnspectlon fee for the uncompleted work. InspecUon fees do not carry over from one REI to
another.
A servlce charge of $30 wtll be added for all dlshonored checks.
I hereby certify that I inspected the electrical installa6on herein on the dates stated: For Department Use Only
Rough - In Inspection(s) Date
�
Final Inspection
i ms macenai can o�
TDD (651) 297-4198.
REI 02 (6/0�
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