P - 75588Minnesota De
443 Lafayette
St Paul, MN
Phone: (651�
TTY/MRS: ( ,
�nt of Labor and Industry
North
) 297-4188
Request for Electrical
Rough-In Inapec�on Required?
9"8'08 � Contractor Must Schedule All Rou
Address of Inspection — Street
1401 GLACIER LN
Owmer Name
RESTORATION PROFESSIONALS
Owner Tetephone Number(s) — Include Area Code(s)
Contractor Name
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Contractor
Yes
— One Family Dwelli
City/Township
FRIDLEY
Projed Descrip�on
TEMP SERVICE
iated Structure
❑ Ready Now
All Final Ins ctions n Will Schedule
County
ANOKA
Conbactor Mailing Address
6041 189TH LN NW AN014A MN 55303
Con4ractor-E-mail Address Electrical Udlity
----
�oP�� • CONNEXUS
Contractor License Number Job/Project Contact Per,
CA02178 DEVERN MATSON
Fee Calculation
Idew Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0— 400 am�re (� $35 New Service/Power Supply �' 0— 400 ampere �$35
Dlew-DweAing Senric�//Power Supply 401— 800 ampere �$60 New Senrice/Power Supply 401— 800 ampere @$60
nvelUng Feeders/Circuits New/Extended Fe�ers/Circuiffi — Up to 15 FeedersJCircuits
U to 30 Feeders/Circuits -$100 Feeders/Circuits $6 Each or 16 to 30 $100
�ome — More than 30 Feeders/Circuits (in addi�on to New/Extend FeederaJCircutts — More Then 30 Feeders/Circuits
Feeders/Circuits U To 200 A $6 Each Feeders/Circuits U to 200 A $6 E�ach
(Specifjr) Reconne F�ders/Circuits
Detached Garage or Other Assoclated Structure
New Servicc�//Powrer Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) � $6 Each
( ) Feeders/Circuits $2 Each �
Detached Garage or Other Associat� Structure
New Service/Power Supply 0— 400 ampere �$35
New/Extended Feeders/Circui� ( ) @ $6 Each
Reconneded Feeders/Circuits ( ) a� $2 Each
Other (SPecifY) , ,,, � , ,a .�__ -�
�C� ���
i � 1�,�U, ,-� lJ
Total (the fee calculated above or $35 mulUplied TOtel (the fee calculated above or $�5 mulUplied
by the number of required inspecUon trips, by the number of requir� inspectlon trips,
wrhichever ts grea6er) whichever is greater)
Requ�ts for Electrical Ir�pectlon (REI) with a fee ot S2b0 or less expire 12 montlre from the flling date. Tha contrector must have the work
the 12 month pe�lod or submft enother REI thet irtclud� the 6repeetlon fee for the wicompleted vrork. I�pection fe� do not carry ove
another.
A aervtce charge of S30 wiil be added for aU dtshonored checks.
Rough — In Inspection(s)
nerem on tne aat� ;
Date
ror oepa
���� �� l `�
Final Inspection Date '°�
� 9�1� �o RF(�'D S E P 10
This material can be r�de available In dlfiereM torms,'�such as large print, Braille or on a tape. To requ�t
TDD (Bb1) 287�198.
REI 02 (6/0n
$�� �
pteted w(thin
one REI to
Voice or