P - 75213Minnesota Departrnent of Labor and Industry
443 Lafayette R, d North
St Paul, MN 55-4342
Phone: (651) 5064
TTY/MRS: ( ) 297-4198
wrww.electri .state.mn.us
Con tor Re uest for Electrical
Date Rough-In Inspedion Required?
1/16/08 Contrador Must Sc�edule All Rou�
Addrresss of Inspe�ion - Strs�t
7475 MELODY DR
Owner Name
JERRY WISS
Ovmer Telephone Number(s) - Indude Ar�a Code(s)
(763) 784-0552
Yes
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REC'D � � A� 2� 200�
— One Fam
FRIDLEY
Projeat D�iption
BATHROOM REMODEL
Contractor ldame Contrador Mailirtg Address
STONEY CREEK ELECTRtC, INC. 2034 138TH AVE NW ANDOVER MN 55304
-- - �- - — --- Elec�nc
(763) 757-1581
Contrador Authoriz�
�
CoMrador License Number
CA03665
Fee Calculation
New Home or Associated Structur�
New DwellingService/Power Supply 0- 400 ampere @$35
New Dwelling Senrice/Power SuPPIy 401 - 800 ampere @$60
New Dwelling Feeders/Circuits
- �l ta 3fl Feeders/€ircuif� - �1 O�D ---
Nlcui Nnmc _ Mnra 4hsn �fl F�eloerJ� _irr� �i4c /in arielfinn M
Detached Garage or Other Associate�i Structure
New ServicelPower Supply 0- 400 ampere �$35
New F�ersJCircwits ( ) � $6 Each
(Speciij►)
AARON
���
ENERGY
Structure
Ready Now
� Will Sch�ule
Existing Home/Structure Remodel or Addition
New Service/Powrer Sup ��� 0- 400 ampere @$35
New Servic�/Power Supply 401 - 800 ampere �$60
New/E�derM� Feeders/Circa�its - Up to 15 Feeders/Circuds
- 2 fe�ers�CiraiiCs $6 �ac�i or t6to-30 $(�0 - - - - $�- --
NeiwfFufanriatl FmriamJ(`irr��itc _ Mnre Thnn �fl Fmlorc/(_irr��ifn
(�' }-Fe�ders/Circuits Up to 200 A@$6 Each
Rec�nneded Fe�ers/Circuits
( !C� ) FeedersJCircwits @ $2 Each I
Detached Garage or Other Assoclate� Structure
New Senrice/Power Supply 0- 400 ampere @$35
IdewiExtended Feeders/Circuits (
Reconnected �ers/Circ�ifs (
) @ $6 Each
) @ $2 Each
Tot81(the fee calc�lated above or $35 multiplied Tot'dt (the fee calcvlated above or $35 multiplied
by the number of required inspecbon trips, by the number of required ins�on trips,
rahichever is greater) whichever is greater) $70
Requesffi for Electrical4ispecUan (REI) wlth a fee oi 5260 � lass e�pire 12 moMhs irom ti� fpi� date. The contractor m�t have tlre wwk completed wfU�in
the 12 moMh period or submk another REI ttmt Includes Ure Inspecticn tee tor tl�e um�i�pteted vrork. Inspectlon fees do rrot carry orer Troom one REI to
artother. '
A servtce cf�azga of S30 �rlll be added for �i dishonored ehecks.
Rough - In Inspedion(s)
Final Inspedion
Thls mateNal can bi
TDD (6b1) 287�188.
REI 02 (6/0�
eledrical inslallaHon herein on tFie dates slated: For De�rtmeM Use
Date
� /-�7, d�'
Date
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Ilable In dif(erern Torrr�, su h as large print, Brallle or on a tape. To requ�t, call 7�OQ
or