P - 75614Minnesota Departrnent of Labor and Industry
443 Lafayette Road North
St. Paul, MN ,�5155-4342
Phone: (65 : 84-5064
TTY/MRS: ' 51) 297-4198
www.ele ity.state.mn.us
Co actor Re uest for Electrical Ins ection — One Famil Dwellin /Associated Structure
Date Rough-In Inspection Required? ❑ Yes Single Inspection Other Than Rough-In: � Ready Now
8/18/2008 Contractor Must Schedule All Rou h-In Ins actions Contractor Must Schedule All Final Ins ections 0 Will Schedule
Address of Inspection - Street CitylTownship County
6831 MADISON STREET NORTHEAST FRIDLEY ANOKA
Owner IVame Project Description
DARLENE HALVORSON 111152 WIRING OF ELECTRICAL SERVICE
Owner Telephone Number(s) - Include Area Code(s) UPGRADE
(763) 571-6899
Contractor Name Contractor Mailing Address
HARRISON ELECTRIC 3440 KILMER LANE NORTH, PLYMOUTH, MN 55441
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(763) 544-3300
Co or Authorized Signature Contractor License Number Job/Project Contact Person
CA00808
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0- 400 ampere @$35 New Service/Power Supply 0- 400 ampere @$35 $35
New Dwelling Senrice/Power Supply 401 - 800 ampere @$60 New Service/Power Supply 401 - 800 ampere @$60
-New Duvelling F�Circuifs --- New/Ex�ended �eeders/Circuits = Up to 15 Feeders/Circuits ' �
U to 30 Feeders/Circuits -$100 2 Feeders/Circuits $6 Each or 16 to 30 $100 � � 2
Wew Home - More than 30 Feeders/Circuits (in addition to New/Extended Feeders/Circufts - More Than 30 Feeders/Circuits
above Feeders/Circuits U To 200 A $6 Each Feeders/Circuits U to 200 A $6 Each
Other (Specify) Reconnected Feeders/Circuits
16 Feeders/Circuits $2 Each �32
Detached Garage or Other Associated Structure Detached Garage or Other Associated Structure
New Service/Power Supply 0- 400 ampere cL'0 $35 New Service/Power Supply 0- 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each New/Extended Feeders/Circuits ( ) @ $6 Each
Other (Specifjr)
Reconnected FeedersJCircuits ( ) @ $2 Each
SU�r'Ch .rJO
TOtal (the fea calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of r�uired inspection trips, '-'7� C�
whichever is greater) whichever is greater) I J
Requesffi for Electrical Inspectlon (REI) wlth a fee of $250 or less explre 12 months from the flling date. The contractor must have the work completed wlthln
the 12 month period or submtt another REI that Includ� the Ir�specUon fee for the uncompleted work. Ir�spection fees do not carry over from one REI to
another.
A servlce cherge of $30 will be added for all dtshonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated: For Department Use On
Rough - In Inspection(s) Date � ^ "� � � p�j � `�
o�-r-v �,.7 J
Finallnspection Date �� AU�1 �`� �008
�- 29- �
Thls materlal can made avallable In dlfierent Torms, such as large print, Brallle or on a tape. To requ�t, call 7-800-342-5384 (p�pL_DLI) Volce or
TDD (651) 287-4198.
REI 02 (6/0�