P - 76826Minnesota rtment of Labor and Industry
443 Lafay Road North
St. Paul, 55155-4342
Phone: ( ) 284-5064
T1Y/M (651) 297-4198
www.el 'aty.state.mn.us
Co tractor Re uest for Electrical
Date Rough-In Inspedion Required?
12/7/2007 Contractw Must Schedule All Rou
Address of Inspedion — Street
5794 HACKMANN AVE
Owner Name
DONALD KERNER
Owner Telephone Number(s) — Indude Area Code(s)
(763)571-3720
Contractor Name ConU
Yes
— One F
���7-�,��� �
RECD D E C-? 2007
Dwellin_ /Associated Strvcture
�ther Than Rough-In: � Ready Now
Cor�trador Must Schedule All Final Ins 'ons V1fil1 Schedule
Citylfawnship CouMy
FRIDLEY ANOKA
SERVICE UPGRADE
ELECTRIC TODAY, LLC 1099 140TH LANE NW - ANDOVER, MN 55304
Contractor Telephone Number Contrador E-mail Address Electrical Utility
767-1410
Contra uthorized Signature Contractor License Number Job/Project Contad Person
�/� CA02202 DAVE 612-221-3215
% 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 G C f'l 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60 New Servioe/Power Supply 401 — 800 ampere @$60
New Dwelting FBeders/Circuits New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits
U to 30 Feeders/Circuits -$100 Feeders/Circuits $6 Each or 16 to 30 $100
New Home — More than 30 Feeders/Circuits (in addition to New/Extended Feeders/Circuits — Mone Than 30 Feeders/Circuits
above Feeders/Circuits U To 200 A $6 Each Feeders/Circuits U to 200 A $6 Each
Other (Specifi�) Reconnected Feeders/Circuits
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other (Specify)
$35
$28
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnecxed Feeders/Circuits ( ) @ $2 Each
Other (Speciy)
�Z(�l C�� il,LG,f' . � ��
TOtal (the fee calculated above or $35 multiplied TOt11(the fee calculated above or $35 mul6plie2�
by the number of required inspection trips, by the number of required inspection trips, $63 ���1
whichever is greater) whichever is greater)
Requests for Elactrical I�pection (REI) with a fee of 5250 or less expiro 12 months from the fiUng date. Trie contractw must have the vrork completed wlthln
the 12 month pe�iod or submit another REI that ir�cludes tfie inspection fee for the uncompleted w�ork. (nspection fees do not carty over from one REI to
anotfier.
A service Charge of f30 will be added for atl dfshono�ed Cllecks.
1 hereby certify that I inspeded the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
Final Inspec:tion
This mate�ial can be made available in
TDD (651) 297�198.
RE102 (6/0�
, / 2 -� �C _
forms, such as I
o► on a tape. To request, call 1
or