P - 75644AAinnesoia Departrner�f of Labor and I�ustry
443 Lafayette Road `o�
St Paul, flAN 551 ' 2 . .
Phone: (651)
TTY/AARS: (651) 7-4198
www.electricihr. te.mn.us
� Homeowner
�� Rough-In Ir�pec°4fln Requireat?
Address of Inspec6on - Street
506 HUGO ST NE
Uwner Name
ANDREW VEWTURA
Owner Telephane NumbeKs) - Ir�ude Area Code(s)
(763) 78352462
Owrner Mailing A�ress — Street
50S HUGO ST (dE �---
�st for Electrical Inspectio
Yes ����on Otl�er Than Rough-!n:
R�ay nbw
v�n s�,aa�,ae
Citylfownship Caunty
FRIDLEY ANOKA
Project D�ription
BATHROOM REMODEL, REWIRING FOR SEPARATE
BREAKER COIdNECTION
-- `7 a --- g� a FRIDLEY
State Zip Coda
MN 55432
Owner E-ma� Address Electrical Utility
agv5158@nji�edu XCEL
By sigrring this doai�r� I certify that I am the o�mer as defined by AAinn. Stat § 326.07 artd wria legally per%rm the electrical work
OvKier Signatiue
F�e Calculation
Nevv Home or Ass�ciated Struct�re
Newr Home Service/Power Suppty 0— 400 ampere �$35
IVewr Hame Service/Powrer Supply 4M — 800 ampere �$60
tdevv Home FeedersfCircuits
Up to � Feeder�Cea�ts - $9 �
New Home — More than 30 Feeders/Circuiis (in adcFition to
above) ( ) Feeders/Circuits Up To Z00 A � Ead�
Other (Specify)
E?etach�t E�arage or Other Associated Structure
Newr Senrioe/Power SuAPty U— 400 ampere � S35
Nevu FeederslCircuits ( ) � $6 Eacfi
Other
Existiing Hame/Strudure Remodef or Addition
Hew Senrice/Pawer Su�1y 0— 400 ampere @ S35
Weu►r Servi�eJPawer Supply 407 — 8� ampere @�0
New/E�Med Feede�slC� — Up to 15 Feedets/Cira�s
i FexderalCgaids $S Each or 16 to � $i�
NewlFxtemled Feede�/Cncaafts —�llare Than 30 Feede�►C'rr�
E�l�f�ed �arage or Otfi�er Associatied Str�re
New Serv�/Power Supply 0— 4� ampere �$35
New/Fxtended F�derslCirc�ifis ( ) � � Eacl�
Reoonneded Feeders/Cira�ds ( ) � $2 Each
Totel (the fee calc�hated above or $35 mu�fied Total (tlre tee cal�labed atwve or $� m�pTied
by the number of required 'ms�ion trips, by t�e rtumber of requir�l6�on trips,
whichever is greater) whic�ever �; greate�
Requests for Bectricel h�� (� arith a fee af S�0 or [ess e�ire 12 mantl�s irom the dat� ThE oamer must have the wark completed w
12 mo�rth p�lod or suhmtt arta�er RB that dtdudes Uie 6�p� T�e fm the mtcanple�! k Irtspedlan fees da Flot
carry wrer flwn one REI �
A xndce cha W S3� wID be added for aA ed ct�chs.
I hereby certiry that I�Speded Uia e�drim�l � F�aefi on the dates Far �r�rterR U� ONy
Rough — In Inspec�ian(s) pate�. '
Final Irtspecticn Qate ����� � �J �
" ���-t �_�., � o �� .! !JN 0 3 2006
This material can be made avaiFable in difterent forms, such � large prirrt, Braifle or on a ffipe. To requ�t, ca111 �00342d364 (DIAL-0LJ�
7DD (651) �Td7�.
REI 01 (6/0�
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