P - 75288Minnesota Depa ' ent of Labor and Industry
443 Lafayette R' d North
St. Paul, MN - 155-4342
Phone: (65 84-5064
TTY/MRS: 51) 297-4198
Confi�actor Re uest for Electrical
Date Rough-In Inspec4on Required7
1-8-08 Contractor Mu&t Schedule All Rou�,
Address of Inspec4on — Street
/'�� GARDENA LANE
Owner Name
TIMBERCRAFT HOMES
Owner Telephone Number(s) — Include Area Code(s)
Contractor Name
LAZER ELECTRIC
Contractor Telephone I
:tion — One Fam
y� Single Inspecl
��g- ���
I�l� U � H 9�1 � .o �o0u
Dwelling/Associated Structure
�ther Than Rough-In: � Ready Now
ahedule All Final Ins�ections n�II Schedule
FRIDLEY � ANOKA
Project Description
WIRE ADDITION.
8164 ARTHUR STREET NE, SPRING LAKE PARK, MN 55432
Contractor E-mail Address Electrical Utility
Contractor License Number
CA01110
Fee Calculation
New Home or Assoclated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Serv(ce/Power Supply 401 — 800 ampere @$60
Up to 30 Feeders/Circufts -
— More than 30 Feeders/Circuits (in additlon to
To 200 A
Detached Garage or Other Assoclated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits
Other (Soecifv)
Other
( ) @ $6 Each
Job/Project Contact Person
CHUCK SCHWIETERS
Exlsting Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampare @$35
New Service/Power Supply 401 — 800 ampere @$60
New%ExtendedFeeders7Circuits = Up to �5 Feede�i�cuits
Feeders/Circuits $6 Each or 16 b 30 $100
New/Extended Feedars/Cimuita _ Mnrra Th�r, an F�.�a�irs.,,���re
to 200 A
( ) Feeders/Circuits $2 Each �
Detached Garage or Other Assoclated Structure
New Service/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Other lSoecifv)
Total (the fee calculated above or $35 multlplied Totel (the fee calculated above or $35 muttlplied
by the number of required inspectlon trips, by the number of required inspectlon Mps, ��c �
whichever is greater) whichever is greater)
Requests for Eleetrical Inspectlon (REI) with a fee of $250 or less expire 12 months from the flling date. The contractor must have the work completed within
the 12 month period or submit another REI that Includes the InspecUon fee for the uncompleted work. Inspection fees do not carry over irom one REI to
another.
A servlce charge of $30 wlll be added for all dlshonored checks.
I hereby certffy that I inspected the electrical installa8on herein on the dates stated: For Depertrnent Us� pnly
Rough — In Inspection{s) �_�1 f.�-8-� Date
�/�_�� '`�
7
Final Inspecti Date
�^ � ��
Thts mater(al can be made available in dlfferent forms, such as large print, Braille or on a tape. To requ call 1-800-342-5354 (DIAL-DLI) Voice or
TDD (651) 297�1198.
REI 02 (6/07)