P - 76821Minnesota Depa ent of Labor and Industry
443 Lafayette d North
St. Paul, MN 155-4342
Phone: (6 84-5064
TTY/MR 51} 297-4198
www.elec iciry.state.mn.us
Contractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
10-24-07 Contractor Must Schedule All Rou h-In I
Address of Inspection - Street
136 HORISON CIRCLE
Owner Name
YURICH HOMES �' � °�-3
Owner Telephone Number(s) - Include Area Code(s)
(763) 753-6081
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REC�p Nou 2 0 200�
tion - One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: ❑ Ready Now
�ctions Contractor Must Schedule All Final Ins ections ✓� Will Schedule
Ciry/Township Counry
FRIDLEY ANOKA
Project Description
NEW HOME
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Contractor Name Contractor Mailing Address
BOB KILIAN ELECTRIC CO. 12075 43RD STREET NE ST. MICHAEL MN 55376
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(763) 497- 6 bkilianelectric@hotmail.com CEL ENERGY
-ea ract tho ized Signat e Contractor License Number Job/Project Contact Person
` _ ��� CA01001 AM 1997
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply� - 409�mpere @$35
New Dwelling Service/Power Supply 401 - 800 ampere @$60
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New Home - More th�n 30 Feeders/Circuits (in addition to
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above) (/-*-C ) Feeders/Circuits Up To 200 A@$6 Ea�
Other (Specify)
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
Other (Specify)
0 - 400 ampere @ $35
( ) @ $6 Each
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Total (the fee calculated above or $35 multiplied
by the number of required inspection trips,
whichever is greater)
Existing Home/Structure Remodel or Addition
$35 New Service/Power Supply 0- 400 ampere @$35
New Service/Power Supply 401 - 800 ampere @$60
- {+�wlEx#snu..�o-Fe€:ers/�,i:c�]#s--:1p �� �5 Feed�rs/Cir�uir�
$100 Feeders/Circuits $6 Each or 16 to 30 $100
New/Extended Feeders/Circuits - More Than 30 Feeders/Circuits
Feeders/Circuits U to 200 A $6 Each
Reconnected Feeders/Circuits
( ) Feeders/Circuits @ $2 Each �
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
TOtal (the fee calculated above or $35 multiplied
by the number of required inspection trips,
whichever is greater)
Requests for Electrical Inspection (REI) with a fee of E250 or less expire 12 months from the filing date. The contractor must have the work completed within
the 12 month p�riod 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 a30 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated:
Rough - In I spection ) {�.r� _`�.,�. Date
,�-� �r-�� -��
Final Inspectio Date
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This material made available in diff ent forms, such as larg pri
TDD (651) 297-4198.
REI 02 (6l07)
For Department Use Only
0
or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or