P - 75393. Minn�sota Depa ent of Labor and Industry
� 443 Lafay�tte R d North
St. Paul, MN 5 55-4342
Phone: (651) -5064
TfY/MRS: (6 , ) 297-4198
www.electrici .state.mn.us
Contra tor Re uest for Electrical Ins ection — One Famil Dwellin /Associated Structure
Date Rough-In Inspection Required? ✓ Yes Single Inspection Other Than Rough-In: Ready Now
9/29/08 Contractor Must Schedule All Rou h-In Ins ections Contractor Must Schedule All Final Ins ctions ✓� Will Schedule
Address of Inspection - Street City/Township County
8027 FAIRMONT CIRCLE FRIDLEY ANOKA
i Owner Name Project Description
MYRNA KOSTUCH ADDITION
Owner Telephone Number(s) - Include Area Code(s)
(763) 786-7401
Contractor Name Contractor Mailing Address
SUPERIOR HEAT & ELECTRIC 3731 THURSTON #108 ANOKA MN. 55303
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(763) 422-1721 SUPHVAC@QWEST.NET EXCEL ENERGY
Co or Authori ture Contractor License Number Job/Project Contact Person
CA02449
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0- 400 ampere @� $35 New Service/Power Supply 0- 400 ampere @$35
New Duvelling ServicefPower Supply 409 - 800 ampere @$6E}- New Service/Power Supply 401 - 800 ampere �$60
New Dwelling Feeders/Circuits New/Extended Feeders/Circuits - Up to 15 Feeders/Circuits
U to 30 FeederslCircuits -$100 2 Feeders/Circuits $6 Each or 16 to 30 $100 �� 2
New Home - More than 30 Feeders/Circuits (in addition to New/Extended Feeders/Circuits - More Than 30 Feeders/Circuits
above Feeders/Circuits U To 200 A $6 Each Feeders/Circuits U to 200 A $6 Each
Other (Specify) Reconnected Feeders/Circuits
16 Feeders/Circuits $2 Each $32
Detached Garage or Other Associated Structure Detached Garage or Other Associated Structure
New Service/Power Supply 0- 400 ampere @$35 New Service/Power Supply 0- 400 ampere @$35 ��
New Feeders/Circuits ( ) @ $6 Each New/Extended Feeders/Circuits ( ) @ $6 Each
Other (Specify)
Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Specify) Other (Specify)
���r � � ����r
Total (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) $89
Requests for Electrical Inspection (REI) wlth a fee of $250 or less expfre 12 months from the filing date. The contractor must have the work completed within
the 12 month perlod or submit another REI that Includes the inspecUon fee for the uncompleted work. Inspechon fees do not carry over from one REI to
another.
A service charge of $30 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough - In Inspection(s) Date ^ ,, _ ��'� � �� �
�
l� � i _� c�Y a.� �C�
Finallnspecti , Date
� �,-�-�--� ��3�r�� +�� a � r � � �oos
Thls materlal can be made avallable In dlfferent forms, such as large print, Bratlle or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Volce or
TDD (651) 297�d198.
REI 02 (6/07)