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P - 75500Minnesota Depart ent of Labor and Industry 443 Lafayette Ro North St. Paul, MN 55 5-4342 Phone: (651) 2 5064 TTY/MRS: (65 297-4198 www.electricit tate.mn.us Contrac r Re uest for Electrical Ins ection - One Famil Dwelling/Associated Structure Date Rough-In Inspection Required? ❑ Yes Single Inspection Other Than Rough-In: ✓Q Ready Now 09/23/2008 �ntractor Must Schedule All Rou h-In Ins ections Contractor Must Schedule All Final Ins ections ❑ Will Schedule Address of Inspection - Street City/Township County 1079 NORTH CIRCLE FRIDLEY ANOKA Owner Name Project Description ALL AMERICAN HOMES INSTALL 100 AMP FEEDER Owner Telephone Number(s) - Include Area Code(s) Contractor Name Contractor Mailing Address JNK ELECTRIC 321 QUINCY ST NE; MPLS MN 55413 Contractor Telephone Number Contractor E-mail Address Electrical Utility (612) 840-1154 XCEL ntractor Autho ' ed Signature Contractor License Number Job/Project Contact Person CA00905 JOHN KOURI 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 Suppiy 0— 400 ampere @$35 New Dwelling Service/Power Supply 401 — 800 ampere @$60 New Service/Power Supply 401 — 800 ampere @$60 New Dwelling FeederslCircuits New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits U to 30 Feeders/Circuits -$100 1 Feeders/Circuits $6 Each or 16 to 30 $100 $6 New Home — More than 30 Feeders/Circuits (in addition to New/Extended Feeders/Circuits — 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 Feeders/Circuits $2 Each Detached Garage or Other Associated Structure Detached Garage or Other Associated Structure New Service/Power Supply 0— 400 ampere @$35 New Service/Power Supply 0— 400 ampere @$35 New Feeders/Circuits ( ) @ $6 Each New/Extended Feeders/Circuits ( ) @ $6 Each Other (Specify) Reconnected Feeders/Circuits ( ) @ $2 Each Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied by the number of required inspection Uips, by the number of required inspection trips, $35 o S� whichever is greater) whichever is greater) Requ�ts for Electrical Inspedion (REI) wkh a fee of $250 or less expire 12 months from the flling date. The contrector must have the work completed within the 12 morrth period or submlt another REI that includes the Inspection fee for the uncompleted work. Inspection fe� do not carry over Trom one R o' another. A service charge of $30 will be added for all dishonored ch�ks. I hereby certify that I inspected the electrical installation herein on the dates stated: For Department Use Only Rough - In Inspection(s) Date '�.�� -r� I °�. � � Fy�al Inspection . f Date �� r � g�� ( ✓ �� , �, � o�, This materi I n be made avallable In dffferent forms, such as large print, Braille or on a tape. To request, call 1-500-342-5354 (DIAL-DLI) Voice or TDD (651) 2 7-4198. REI 02 (6/07)