P - 76666Minnesota Depa ent of Labor and Industry
443 Lafayette R d North
St. Paul, MN 55-4342
Phone: (651) 5064
TTY/MRS: 1) 297-4198
www. .state.mn.us
Contr ctor Re uest for Electrical
Date Rough-In Inspedion Required?
11-7-07 Contrador Must Schedule All Rou
Address of Inspec6on — Street
5149 HORIZON DR.
CHRIS NUTTING
572-2369
LEW ELECTRIC
Contractor Telephone Number
(612�'$�1-5364 ,-,
Area
��� -C����-
REC'D D� C- 3 Z007
tion — One Famil Dwellin /Ass�
Yes Single Inspection Other Than Rough-In:
sctions Contrador Must Schedule All Final Insp
FRIDLEY � ANOKA
Project Description �
WIRE UP DETACHED GARAGE
Corrtractor Mailing Address
1583 106TH AVE NW COON RAPIDS MN 55433
Cor�tractor E-mail Address Ele�ctriql Util
Corrtractor License Number
.. CA05011
Fee Calculation
New Home or Associated Structu►�e
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere �$60
to 30
Home —
s-
t0
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
DAN LEW
Structure
] Ready Now
] Will Schedule
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Senrice/Power Supply 401 — 800 ampere �$60
New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits
— More Than 30 Feeders/Ci
ts Uo to 200 A Cdt S6 Each
Reconneded Feeders✓Circuits
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)
TOtAI (the fee ca�ulated above or $35 multiptied 7otel (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, ��`�
whichever is greater) $35 whichever is grea ��
Raqt� for FJecLir.d Ir�peetion (REI) with a fee i250 or less eupMe 12 mo� froia iiling date. The conbactor must hawe U�e work compleEed within
the 12 maqh period or submlt another REJ thaR includes the inspaction fee for the plQted work. 4ispedion �es do not pIR�► over irom one REt to
another.
A service charge af i30 w�I be added for a� dishonored chseks.
Rough — In Inspedion(s)
n ��/_ l
Thls materlal can be made avallable In
TDD (651} 297�4198.
REI 02 (6/0�
on vie aates statea:
Date
�= �
Date
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forms, such as large p�lnt, Brallle or on a tape. To request,
or