P - 75653Minnesota De� rtment of Labor and Industry
443 Lafayett '�oad North
St. Paul, M 55155-4342
Phone: (6 2845064
TlY/M RS (651) 297-4198
www.ele 'city.state.mn.us
Co actor Re uest for Electrical
Date Rough-In Inspection Required?
06/24/2008 �ntractor Must Schedule All Rou
Address of Inspection — Street
1240 ONONDAGA ST
Owner Name
TANYA HENDRICKS
(�wnark�Q„nhanr.� Numhcr/s1— Inrtl��rlr�, Orr�a C`.rvlafel
ctor Name
J K ELECTRIC
Contractor Telephone Number
(612) 840-1154
tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: ✓� Ready Now
rctions Contractor Must Schedule All Final Inspections ❑ Will Schedule
FRIDLEY
WIRE A/C
Contractor Mailing Address
321 QUINCY ST NE; MPLS MN 55413
Contractor E-mail Address Electrical
CEL
ANOKA
Signature Contractor License Number Job/Project Cont�
«
CA00905 JOHN KOURI
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Dwelling Feeders/Circuits
Up to 30 Feeders/Circuits - $100
New Home — More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A Ca� $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
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 Feeders/Circuits
1 Feeders/Circuits $6 Each or 16 to 30 $100
New/Extended Feeders/Circuits — More Than 30 Feeders/Circuits
( ) Feeders/Circuits Up to 200 A@$6 Each
( ) Feeders/Circuits $2 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
�
Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied 3 ��t �
by the number of required inspection trips, by the number of required inspection trips, �.
whichever is greater) whichever is greater)
Requests for Electrical Inspedion (REI) wkh a fee of $250 or less expire 12 months from the flling date. The contractor must have the work completed wfthin
the 12 month period or submit another REI that includ� the inspection fee for the uncompleted work. Inspection fees do not carry over from one REI to
another.
A service charge of $30 will be added for all dishonored checks.
I hereby certiiy thffi I inspected the electrical instaliation herein on the dates stated: For epart ent Use Only
Rough — In Inspection(s) Date . , �
Final Inspection
This material can be made
TDD (651) 287-4198.
REI 02 (6/07)
Date �
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