P - 75583Minnesota Department Qf Labor and Industry
443 Lafayette Road,Plsii`th
St. Paul, MN 551 �342
Phone: (651) "5064
TTY/MRS: ) 297-4198
www.ele .state.mn.us
Cont ctor Re uest for Electrical I
Date Rough-In Inspection Required?
08/16/2007 Contractor Must Schedule All Rou I
Address of Inspection — Street
1469 ONONDAGA ST NE
FIDEL ONOFRE
��( `� -C�l� /S
REC'D AU G 2 0 2007
tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: � Ready Now
�ctions Contractor Must Schedule All Final Ins ections �❑ Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description � ,
WIRE/ RECONNECT AIR CONDITIONER
vm iGi 1 CICfJ11U11C IVUI I IUCI,S f— II IIiIUUC /11Cd VUUC�3 f
(763) 257-3099
Contractor Name Contractor Mailing Address
CENTERPOINT ENERGY 9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor Telephone Number Contractor E-mail Address Electrical Utility
(763) 757-6202 joann.zinken@CenterPointEnergy
j� ntracto Au ori S' atu� Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Dwellina Feeders%Circuits — � -
to 30 Feeders/Circuits - $100
New Home — More than 30 Feeders/Circuits (in �
abovel ( ) Feeders/Circuits Uo To 200 A
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other (Specify)
New Service/Power Supply
New Service/Power Supply
Feeders/Circuits
0 — 400 ampere @ $35
401 — S00 ampere @ $60
— Up to 45 Feeders/�ircuits
New/Extended Feeders/Circuits — More Than 30 Feeders/Ci
( ) Feeders/Circuits Up to 200 A@$6 Each
Reconnected Feeders/Circuits
( ) 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 $2
Other (Specify)
Total (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, ���
whichever is greater) whichever is greater)
Requests for Electrlcal InspecUon (REI) wlth a fee of $250 or less explre 12 months from the flling date. The contractor must have the work c eted within
the 12 month perfod or submft another REI that includes the inspecUon 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 certify that I inspected the electrical installation herein on the dates stated: For Department Use OnIY
Rough — In Inspection(s)
Final Inspection
i ms matenai can oi
TDD (651) 297-4198.
REI 02 (6/0�
Date
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dlfferent forms, such as large'��t, Brallle or on a
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