P - 76881Minnesota rtment of Labor and Industry
443 Lafayette oad North
St. Paul, MN 5155-4342
Phone: (65 284-5064
TTY/MRS: 51 } 297-4198
www.ele 'ty.state.mn.us
Gon actor Re uest for Electrical
�� Rough-In Inspe�tion Required?
10-12-07 Contractor Must Schedule All Rou
�aaares:s v� �na�cmvn — �ua�
75'c0 JACKSON ST NE
MRS PAT BERRY
— indude Ar�ea
(763) 784-9367
Contractor Name
K E ELECTR(C LLC
Contractor Telephone Ni
f6121819-9839
o��b`�-�`�I7S
R�C'D O C T 2� 9 2007
tion - One Famil Dweilin /Associated Structure
Yes Single Inspedion OtherThan Rough-In: Ready Now
u�inne Cnntrgrlor Must Schedule All Fins! Ins�ections n Will SCheduN
FRIDLY
FURNACE RECONNECi'
12320 FLETCHER LANE ROGERS, MN 55374
Contractor E-mail Address Electricai t
ANOKA
!'� I CA04652 � KEITH ERICKSON
Fee Calculation
New Home or Asaociated Structure Existing Home/StruGture Rsmodel or Addltion
New OweiGng Service/Power Suppiy Q— 400 ampere �$3S New ServiceiPower Suppy 0— 400 ampere � 335
New Dwelling Service/Power Supply 401 �- 800 ampere (� S60 New Servioe/Power Supply 401 — 800 ampere �$60
New DwelGn� Feeders(Circuifs ---- - _--- New/Extended FeedeB/Circuits — Up to 15 Feeders/Cirr,uits
i�., �„ zn Gm���r���� _ s�nn ! 1 FeederslCirc�its � S6 EaCh or 16 !0 30 �$'!00
— More than
To
Detached Garage or Other Associated Structure
New Service/Povrer 5upply �— 400 ampere �$35
New Feeders/Circuitss ( ) � 36 Each
to
Detached G�rage or Other Assoclated Structure
New ServioelPower Suppy 0— 400 ampero � 835
NewlExtended Feeder$/Circuits ( ) � Ss Each
Reconnected FesdersiCirCuits ( ) � 92 Each
$2
TOtill (the tee calculeted above or $35 multiplied TOtat (the fee calculated above or a35 multplied
by the number of required inspectlo� trips, by the number of required inspedion Mps, $35
whichever is greeber) whichever is greater)
Requests for ElecMcal Inspectlon (REq wlth a tee of i2b0 or leas explre 12 montl�s irom the llling date. The contra�tor must have the woek completad wkhtn
ths 12 moMh period or aubmk another REI that includes fhe inspectton tee for the uncompletad work. Inspacdon faee do not carry ovar from ane REI to
anather.
A service eAan�e of iS0 wltl de added for all dishonored d�ecks.
1 hereby Certi/y that I inspeCted the elecpiCal inatal�ation haroin on the dates stated: For 06pattrMnt Use Only
Rough — In Ins�ction(s) Date
Thls mataria! ca� meda avatNible in dil%rsnt forms, sucfi as I�rgq�print, BralNs a on a tape. To raquest,
TDD (661) 287-418a.
REI 02 (6/07)
Volce or