P - 75590Minnesota De
443 Lafayette
St. Paul, MN
Phone: (651)
TTY/MRS: (
www.electri
of Labor and Industry
297-4198
Contr ctor Re uest for Electrical
Date Rough-In Inspection Required?
OS/25/08 Contractor Must Schedule All Rou
Address of Inspection — Street
6357 JACKSON STREET NORTHEAST
Owner Name
DAVE SCHULZE
Owner Telephone Number(s) — Include Area
(763) 516-2768
Contractor Name
HARRISON ELECTRIC INC
Contractor Telephone Number
(763) 544-3300
Sign�ture
s ection — One Famil Dwellin /Associated Structure
[� yeS Single inspection Other Than Rough-In: Q✓ Ready Now
n Insaections Contractor Must Schedule All Final Insoections n Will Schedule
FRIDLEY � HENN
Project Description
SERVICE UP-GRADE, PANEL, METER, AND
THROUGH THE ROOF SERVICE MAST
Contractor Mailing Address
3440 KILMER LANE NORTH
Contractor E-mail Address
mail@harrison-electric.com
Contractor License Number
CA00808
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Servic:e/Power Supply 401 — 800 ampere @$60
to 30 Feeders/Circuits -
New Home — More than 30 Feeders/Circuits (in additlon to
above) ( ) Feeders/Circuits Up To 200 A@$6 Each
Other (Specify)
Detached Garage or Other Associated Structure
New Servicc�//Power Supply
New Feeders/Circuits
Other (Specify)
0 — 400 ampere @ $35
( ) � $6 Each
Person
Existing Home/Structure Remodel or Addition
New Service/Power Supply s_ /t 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere �$60
New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits
Feeders/Circuits $6 Each or 16 to 30 $100
New/Extend� Feeders/Circuits — More Than 30 Feeders/Circults
Feeders/Circuits U to 200 A $6 Each
Reconnected Feeders/Circuits
� Feeders/Circuits $2 Each
Detached Garage or Other Associated Structure
New Servic�/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( � 2)�$2 Each
$35
$24
Other (Specify) Other (Specify)
Ciry surcharge , �
TOtel (the fee calculated above or $35 multiplied TOtal (the fee qlculated above or $3 multiplied
by the number of required inspection trips, by the number of required inspection trips,
whichever is greater) whichever is greater) �o�
Requ�ts for Electrlcal Inspection (REI) wlth a fee of $250 or less explre 12 months from the flling date. The contractor must have the work completed within
the 12 month period or submlt another REI thet locludes the InspecUon fee for the uncompleted wark. lnspectlon fe� do not carry over from one REI to
another.
A servlce charge of $30 will be added for all dishonored checks.
I hereby certlfy that I inspect�i the electrical installation herein on the dates stated: or� partment Use Only
Rough — In Inspection(s) Date �'� ���� �
Final Inspection Date
� ����`---�. �5'Z��� ��
Thls materlal can be made avallable In dlfferent forms, such as large print, Brellle or on a
TDD (651) 297-4188.
REI 02 (6/0�
S pl
E � 2008
request, call
or