P - 75308Minnesota Departrnent of Labor artd Industry
443 Lafayetle Road Nor�
St. Paul, MN 55155-4342
Phone: (651);�845064
Fax: (651) ��4-5749
www.elec�i�ty.state.mn. us
Request far Electrical
Rough-In Inspedion Required?
11/16/08 � Corn
Addr�s of Ins�Ction -
7479 MELODY DR
Oavner Name
JOHN MILLER
Yes
— One
FRIDLEY
For Departrrte� lJ� Ongr
Fund Appr RSC Or�
774 CCL 4570 4220
Rough-In:
►�\i[�7:�1
100A SERVICE CHANGE OUT
vwmer Te�ephone IVum�r�s) - Indude Area Code(s)
(763) 786-2049
Contractor Name Corrtrador Mailing Addr+ess
STONEY CREEK ELECTRIC INC 2034138TH AVE NW ANDOVER MN 55304
Contrec�or Telephone Number Corrtrador E-mail Addregs Eledrical Utility
(763) 757-1581 EXCEL ENERGY
Contrador Authorized Signaturoe Cantrador License Number Job/Project Cor�tact Person
— - - — �- —� �� � . . — -- --- — - - - - -
Structure
] Ready Now
� Will Sc�edul�
/ Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling ServioelPow�er SuPPb �- mPere (� $35 Idew Servioe/Power SuPP�Y 0- 400 ampere aLD $35 $35
L� ,
New Dwelling Servioe/Power SuPPty 401- 8Q0 ampere @$60 Idew �rvioe/pov�er Supply 401- 8� am�re @$6p
Mew Dwelling F�ders/Circ�its New/Extended Fe�ersJCirc�its - Up to 15 F�eders/Circuffs
New Home -
30 Fe�dersJCircuits - $
:ircwits rn addiHon to
Ip To 200 A C�D $6 Each
Detached Garage or Other Associated Structure
Plew Servioe/Power SuPPIy 0- 400 ampere (a3 S35
New Fe�ers/Circuits ( ) � $g ��
to 30
to
Detached Garage or Other Associated Structure
New ServiceJPower Supply 0- 4Q0 am�sere (c,� $35
New/Extended FeedeB/Circ�ii� ( ) � $6 Eadt
R�on�� Fe�ers/Circwits ( ) @ $2 Each
$26
Total (the fee caicwlated above or $35 mutdpli� To�l (tl�e tiee calculated a�ve or $35 multiplied
by the number of re.quired inspedion fips, by the number of required inspedian trips, $61
whichever is greater) whichever is greater)
Re9aeste tar dectrlcal Inspecdon � w�h a fee oi �180 or less explre 12 mo� f�om Ufe fl8ng date. The corttrador muat have tlie Nrork compl� w�
tlre 12 montl� perlod or submit eno�er REI that inciudes tl� q�spectlon � uneomVleted wak InapecN� t�s do not car��r over irom ane Rq m�f �
A serviee chargg ot �SO wtp be ml�d for all d�iwnored checlos.
I herebY certifY that I fr�apec�ed U�e etectricel installatlon herein on the daUes sFated: For DepaAmerK lJs� Only
Rough - In Inspedion(s) p�
Final
Thie maberral can M
'TDD (BS1) 297�188.
REI 02 (11/08)
� �p� WlJ
�_ � � �fi � REC�D � � � � 4 200�
ch as large ille or on a tece. To �u�t: can 9$a1L
or
/