P - 76757Minnesota De rtment of Labor and Industry
443 Lafayett oad North
St. Paul, MN 5155-4342
Phone: (65 284-5064
TTY/M RS: 51) 297-4198
www.elect ity.state.mn.us
Cont ctor Re uest for Electrical Ins
Date Rough-In Inspection Required?
12/11/2007 Contractor Must Schedule All Rou h-In
Address of Inspection - Street
288 LIBERTY ROAD
Owner Name
Telephone Number(s) - Include Area
Contractor Name
JNK ELECTRIC
Contractor Telephone
(612) 840-1154
a���� -� ���
REC'D D � � 12 2007
ction — One Famil Dwellin /Associated Structure
� Yes Single Inspection Other Than Rough-In: ✓❑ Ready Now
�ections Contractor Must Schedule All Final Ins ections ❑ Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description
MOVE METER & INSTALL NEW MAST ABOVE ROOF
Contractor Mailing Address
321 QUINCY ST NE; MPLS MN 55413
ber Contractor E-mail Address Electrical Utility
CA00905
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0- 400 ampere @
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Dwellinq Feeders/Circuits
Up to 30 Feeders/Circuits - $100
Home — More than 30 Feeders/Circuits (in addition to
el ( 1 Feeders/Circuits Uo To 200 A(a� $6 Each
0
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
Other (Specify)
Other (Specify)
0 — 400 ampere @ $35
( ) @ $6 Each
Job/Project Cont�
JOHN KOURI
Existing Home/Structure Remodel or Addition
New Service/Power Supply 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/Extended Feeders/Circuits — More Than 30 Feeders/Circuits
( ) Feeders/Circuits Up to 200 A@$6 Each
Reconnected Feeders/Circuits
( ) 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
JJ �
TOtal (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, $35 .�d
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The contractor must have the work completed within
the 12 month period or submit another REI that includes the inspection fee for the uncompleted work. Inspection fees do not carry over from one REI to
another.
A service charge of 530 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated:
Rough — In Inspection(s) Date
Final Inspection
This material can bi
TDD (651) 297-4198.
REI 02 (6/07)
in different forms,
For Department Use Only
Dat�� I
7
as large print, Braille or on a tape. To request, call 1
or