P - 75716Minnesota Depa�finent of Labor and Industry
443 Lafayette, oad North
St. Paul, M ' 5155-4342
Phone: ( � ) 284-5064
TTY/M . (651) 297-4198
www. 'city.state.mn.us
Contractor Re uest for Electrical I
Date Rough-In Inspection Required?
07/26/2007 � Contractor M
Address of Inspection — Street
7647 JACKSON ST NE
Owner Name
SHARON KOPESKY
Owner Telephone Number(s) —
(763) 784-9428
Contractor Name
CENTERPOINT ENERGY
(763) 757-6202
��C�7 --�� I ���
REC'D AUG - 2 200i
:tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: � Ready Now
:ctions Contractor Must Schedule All Final Ins ections ✓� Will Schedule
CitylTownship County
FRIDLEY ANOKA
WIRE/RECONNECT AIR CONDITIONER
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utiliry
.co
Co actor uth e ure Contractor License Number Job/Project Contaet Person
� CA01796 JOANN ZINKEN
Fee Calculation
New Home or Associated Structure � Existing Home/Structure Remodel or Addition
New Dwelling Servi�/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 Home —
Other (Specify)
to 30 Feeders/Circuits - $100
s/Circuits (in addition to
� Un To 200 A Ca� $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits
Other (Saecifi�)
Other (Specify)
( ) @ $6 Each
�s — �p io �� reec�ersn.uwiw —}-
$6Eachor16to30@$100 I
_ IUnro Than 3(1 Fa�a�rlors/C:irr� �ifc
200 A Ccil $6 Each
Reconnected Feeders/Circuits
( 1 ) Feeders/Circuits @ $2 Each �
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 (Specifv)
�
Tot81 (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, ��
whichever is greater) whichever is greater) ��o .
Requesffi for Electrfcal Inspeetfon (REI) with a fee of $250 or less expire 12 months from the flling date. The corrtractor must have the work completed within
the 12 month period or submft another REI that includes the inapectlon fee for the uncompleted work. InspecUon fees do not carry over from one REI to
another.
A service charge of $30 wtll be added for all dishonored checks.
I hereby certify that I inspeded the ele�trical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
( l� � ' "� �
This material can be made avallable in dtfferent torms, such as large pMnt, Brallle or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or
TDD (651) 297-4198.
REI 02 (6/0�