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Minnesota Department of Labor and Industry
443 Lafayette ,,i�d North , .
St. Paul, MN � 155-4342 S
Phone: (6 284-5064
TTY/MR . (651) 297-4198
www.el "city.state.mn.us
C ractor Re uest for Electrical
Date Rough-In Inspection Required?
7/24/2008 Contractor Must Schedule All Rou
r.uw cas vi n wNCt:u�� i— au �
5986 MCKiNLEY ST NE
ED KAZMIERKOSKI
Owner Telephone Number(s) —
(763) 571-4266
Contractor Name
CENTERPOINT ENERGY
convactor i eiephone
(763) 757-6202
Area Code(s)
s ection — One Fam
❑ Yes Single Inspeci
n Ins ections Contractor M�
City/Township
FRIDLEY
Dwelling/Associ
Other Than Rough-In:
>chedule All Finai Ins ecti
Counry
ANOKA
WIRE/ RECONNECT AIR CONDITIONER
Structure
] Ready Now
] Will Schedule
C:onuactor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utilitv
joann.zinken@CenterPointEn
Contractor License Number
CA01796
Fee Calculation
Home or Associated Structure
New Dwelling Service/Power Sup 400 ampere @$35
New Dwelling Service/Power Supply 401 — S00 ampere @$60
Up to 30
iome — More than 30 Feeders/Circ
) ( ) Feeders/Circuits Up'
(Specify)
�_
to
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits
Other (Soecifirl
( ) � $6 Each
JOANN ZINKEN
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 FeederslCircuits
Feeders/Circuits $6 Each or 16 to 30 $100
New/Extended Feeders/Circuits — More Than 30 Feeders/Circuits
( ) Feeders/Circuits Ua to 200 A C� $6 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
$2
1 Otal (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, �.S�,Sd
whichever is greater) whichever is greater)
Requesfs for Electrlcal InspecUon (REI) with a fee of $250 or less expire 12 months from the fllfng date. The contractor must have the work completed wlthln
the 12 mor�th perlod or subm(t another REI that Includes the 1ns�cUon fee for the uncompleted work. InspecUon fees do not carry over from one REI to
• another. •
A service charge of $30 wlll be added for all d(shonored checks. �
I hereby certify that I inspeded the electncal installat�on herem on the dates stated: F�r oonart.�,A„t � �Qe n..
Rough — In Inspection(s)
Final Inspection
This material can be made avallable in dlffei
TDD (651) 297�1198.
REI 02 (6/0�
Date
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