P - 75481Minnesota Dep ent of Labor and Industry
443 Lafayette pad North
St. Paul, MN 155-4342
Phone: (651) 84-5064
TTY/MRS: (6 ) 297-4198
www.electrici .state.mn.us
Contractor Re uest for Electrical I
Date Rough-In Inspection Required?
07/010/2008 Contractor Must Schedule All Rou I
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243 ELY ST NE
ERICA FISCHER
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(763) 784-8293 (612) 616-2106
CENTERPOINT ENERGY
757-6202
tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: � Ready Now
�ctions Contractor Must Schedule All Final Ins ections ✓0 Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description G,�
WIRE/ RECONNECT AIR COIVDITION
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utility
joann.zinKen(cvicenterromttnergy
Contractor License Number
CA01796
Fee Calculation
Home or Associated Structure
�.._
New Dwelling Service/Power
@ $35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
to 30 Feeders/Circuits - $100
New Home —
Each
(Specify)
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other
Job/Project Contact Person
JOANN ZINKEN
Existing Home/Structure Remodel or Addition
New Service/Power Supply
New Service/Power Supply
Feeders/Circuits
0 — 400 ampere @ $35
401 — 800 ampere @ $60
— Up to _15 Feeders/Circ�its
6 Each or 16 to 30 C�a. $100
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 (Speciry)
$2
TOt11(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 �p
whichever is greater) whichever is greater)
Requests for Electrical Ir►specUon (REI) wlth a fee of $250 or less explre 12 months from the fiUng date. The contractor must have the work completed wtthin
the 12 month perlod or submit another REI that includes the inspecUon fee for the uncompleted work. Inspection fees do not earry over from one REI to
another. -
A servlce charge of $30 wlll be added for all dlshonored checks.
I hereby certity that I inspaded the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date ^��� �� � ���
iX
Final Inspection Date ��p J U L 16 2008
� .^ �
This material can be made available in different forms, such as large t, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or
TDD (651) 297�1198.
REI 02 (6/07)