P - 75562Minnesota Depa ", ent of Labor and Industry
443 Lafayette R d North
St. Paul, MN 55-4342
Phone: (651) 45064
TTY/MRS: 1) 297-4198
www.elect ' .state.mn.us
Contr ctor Re uest for Electrical I
Date Rough-In Inspection Required?
08/13/2008 Contractor Must Schedule All Rou I
Address of Inspection — Street
8310 E. RIVER ROAD
Owner Name
MELVIN LANGE
Owner Telephone Number(s) — Include Area Code(s)
s ection — One Famil Dwellin /Assc
❑ Yes Single Inspection Other Than Rough-In:
n Inspections Contractor Must Schedule All Final Insu
i
/� yI
Structure
] Ready Now
� Will Schedule
FRIDLEY � ANOKA
Project Description
INSTALL SMOKES/CO2'S IN ROOMS WHERE
NECESSARY TO CODE.
Contractor Name Contractor Mailing Address
SOUTH SIDE ELECTRIC, INC. 9201 E. BLOOMINGTON FRWY, BLOOMINGTON, MN 55420
Contractor Telephone Number Contractor E-mail Address Electrical Utilitv
Contractor License Number
i CA01695
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
New Dwelling Feeders/Circuits
New Home — More than 30
Other (Specify)
to 30 Feeders/Circuits - $100
s/Circuits (in addition to
To 200 A
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
(Specify)
Person
Existing 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
to 200 A @ $6 Each
nected Feeders/Circuits
( ) Feeders/Circuits @ $2 Each �
Detached Garage or f�ther Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconneded Feeders/Circuits ( ) @ $2 Each
�v
TOt81(the fee calculated above or $35 multiplied TOtel (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, �
whichever is greater) whichever is greater) �, ��
Requests for Electrlcal Inspection (REI) wtth a fee of $250 or less explre 12 months from the ftling date. The contractor m have the work completed wlthln
the 12 month period or submk another REI that lncludes the Inspectlon fee for the uncompleted work. Inspectton f do not carry over from one REI to
another.
A servlce charge of $30 wlll be added for all dishonored checks.
1 hereby certify that I inspected the electripl installation herein on the dates stated: Fo� epartment US Only
Rough — In Inspection(s) Date
Final
Thls material can be made
TDD (651) 297�L198.
REI 02 (6/07)
� ��'� l�'
Datec � Q� AUG 14 2008
/ �" 1\L
forms, such as large print, Brallle or on a tape. To request, call 9-800-3
Voice or