P - 75665� �so� �
Minnesota Depa. ent of Labor and Industry
443 Lafayette R d North a '
St. Paul, MN 155-4342
Phone: (651 845064
TTY/MRS: 1) 297-4198
www.ele ty.state.mn.us
Contractor Re uest for Electrical Ins ection — One Famil Dwellin /Associated Structure
Date Rough-In Inspection Required? ❑ Yes Single Inspection Other Than Rough-In: � Ready Now
06/30/2008 Contractor Must Schedule All Rou h-In Ins ections Contractor Must Schedule All Final Ins ections ✓❑ Will Schedule
Address of Inspection — Street City/Township County
5312 HORIZON DRIVE NE FRIDLEY ANOKA
Owner Name Project Description
HERNAN CABRERA WIRE/ RECONNECT AIR CONDITIONER
Owner Telephone Number(s) — Include Area Code(s)
(612) 387-7010
Contractor Name Contractor Mailing Address
CENTERPOINT ENERGY 9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(763) 757-6202 joann.zinken@CenterPointEnergy
Contractor Authorized Signature Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
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 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60 New Service/Power Supply 401— 800 ampere @$60
New Dwelling Feeders/Circuits - Nev✓/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 — More Than 30 Feeders/Circuits
above Feeders/Circuits U To 200 A $6 Each Feeders/Circuits U to 200 A $6 Each
Other (Specify) Reconneded Feeders/Circuits
1 Feeders/Circuits $2 Each $2
Detached Garage or Other Associated Structure Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35 New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each New/Extended Feeders/Circuits ( ) @ $6 Each
Other (Specify)
Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Specify) Other (Specify)
TOtal (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied � SU
by the number of required inspection trips, by the number of required inspection trips, ��s �
whichever is greater) whichever is greater)
Requests for Electrlcal InspecUon (REI) with a fee of $250 or less explre 12 months from the fllPng date. The contractor must have the work completed wfthln
the 12 month perlod or submit another REI that Includes the inspection fee for the uncompleted work. Inspectlon fees do not carry over from one REI to
another.
A servlce charge of $30 will be added for all dlshonored checks.
I hereby certify that I inspeded the electrical installation herein on the dates stated: For Department se Only
Rough — In Inspection(s) Date �
C��� a � �I�I �
Final Inspection Date
' f �C'D J U L 11 2008
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Thls material can be made available in dtffererrt forms, such as large p' Brallle or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Volce or
TDD (651) 297�d198.
REI 02 (6/0'�