P - 76813Minnesota Departm t of Labor and Industry
443 Lafayette Ro orth
St. Paul, MN 55 -4342 r�G`
Phone: (651) -5064
TTY/MRS: ( ) 297-4198 Cy(,�
www.electri .state.mn.us
Contr tor Re uest for Electrical In
Date Rough-In Inspection Required?
11/28/2007 Contractor Must Schedule All Rou h-I
Address of Inspection - Street
151 GLEN CREEK ROAD NE
Owner Name
GENEVIVE PETERSON
Owner Telephone Number(s) - Include /
(763) 571-8423
Contractor Name
CENTERPOINT ENERGY
Contractor Telephone Number
(763) 757-6202
Signature
New
Yes
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REC'D � F_ C- 3 2007
— One Famil Dwellin /Associated Structure
Single Inspection Other Than Rough-In: ❑ Ready Now
Contractor Must Schedule Ail Final Ins ections ✓0 Will Schedule
Ciry/Township County
FRIDLEY ANOKA
Project Description
WIRE/ RECONNECT FURNACE
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utility
joann.zinken@CenterPointEnergy
Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
Structure
Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0— 400 ampere @�'35 I I New 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
to 30 Feeders/Circuits - $100
s/Circuits (in addition to
� U� To 200 A Ccil $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits
Other (Specify)
Other
( ) @ $6 Each
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/Circui
( ) Feeders/Circuits Up to 200 A@$6 Each
.............._--- • ----�-� - � ---
( 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
Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Specify)
Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied i0
by the number of required inspection trips, by the number of required inspection trips, �3 j• 5
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of 5250 or less expire 12 months from the filing date. The contrector must have the work completed within
the 12 month period or submit another REI that includes the inspection fee for the uncompleted work. Inspection 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
Final
This material can be made available in different forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or
TDD (651) 297-4198.
REI 02 (6/07)