P - 75482Minnesota De rtment of Labor and Industry
443 Lafayett ,� oad North
St. Paul, M 5155-4342
Phone: (6 284-5064
TTY/MRS: 651) 297-4198
www.ele ity.state.mn.us
Con ractor Re uest for Electrical
Date Rough-In Inspection Required?
9/25/08 Contractor Must Schedule All Rou
Address of Inspection — Street
655 ELY NE
Owner Name
TIM KUENSTING
Owner Telephone Number(s) — Include Area Code(s)
(763) 783-8670
Contractor Name
CARTER ELECTRIC INC
Contractor Telephone Number
(763) 486-7616
ection — One Famil Dwellin /Associated Structure
❑ Yes Single Inspection Other Than Roug�i_In: � �-�eady Now
Ins ections Contractor Must Schedule All Final Ins edions ✓0 Will Schedule
CitylTownship County
FRIDLEY ANOKA
Project Description
REPLACE 100 AMP PANEL WITH 30 CIRCUIT PANEL.
ADD A GENERATOR PANEL.
Contractor Mailing Address
105 TALMADGE WAY NE FRIDLEY MN 55432
Contractor E-mail Address Electrical Utilil
carter.electric@hotmail.com XCEL
Contractor License Number Job/Project Ci
CA04848 BRANDON
Fee Calculation
Idew 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
) Feeders/Circuits - $100
cuits (in addition to
To 200 A C� $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
0 — 400 ampere @ $35
( ) @ $6 Each
Existing Home/Structure Remodel or Addition
New Service/Power Supply Z 0— 400 ampere @$35 I'�J
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
� 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
...��... �..r......�i
Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Specify) Other (Specifjr)
Tot81(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,
whichever is greater) whichever is greater) SO
Requests for Electrlcal InspecUon (REI) wfth a fee of $250 or less explre 12 months from the fllln date. The cor�tractor must have the work completed w(thln ~
the 12 month perlod or submtt another REI that Includes the inspectlon fee for the uncompl work. Inspectlon fees do not carry over from one REI to
another.
A servlce charge of $30 will be added for all shonored checks.
I hereby cerGfy that I inspecte
Rough — In Inspection(s)
Final Inspection
Thls materlal can be
TDD (651) 297�198.
REI 02 (6/07)
on the dates stated:
Date
For Departrnent Use only
�1t.�13��` S��
Dat�� RECD S E P 2 3 2008
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;uch as large pHnt, Brallle or on a tape. To request, call 1-800-342-5354 (DIAL-DLq Volce or