P - 75651Minnesota Depae►�"ient of Labor and Industry
443 Lafayette I� d North • '
St. Paul, MN , 155-4342
Phone: (65 84-5064
TTY/M RS • 51) 297-4198
www.ele city.state.mn.us
Contractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
07/01/2008 �ntractor Must Schedule All Rou h-In
Address of Inspection - Street
1259 ONANDAGA WAY
Owner Name
ANTHONY PEREZ
Owner Telephone Number(s) - Include Area Code(s)
Contractor Name
JNK ELECTRIC
Contractor Telephone Number
(612) 840-1154
�tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: ✓� Ready Now
�tions Contractor Must Schedule All Final Inspections � Will Schedule
FRIDLEY � ANOKA
Project Description
WIRE A/C
Contractor Mailing Address
321 QUINCY ST NE; MPLS MN 55413
Contractor E-mail Address Electrical Utility
t Aut 'zed i ature 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 Dwelling Service/Power Supply 401 — 800 ampere @$60
Up to 30 Feeders/Circuits - $
New Home — More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A(� $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
0 — 400 ampere @ $35
( ) @ $6 Each
New Service/Power Supply
New Service/Power Supply
1
0 - 400 ampere @ $35
401 - 800 ampere @ $60
ts - Up to 15 Feeders/Cirouits
$6 Each or 16 to 30 @$100
- More Than 30 Feeders/Circui
ts Up to 200 A a(�. $6 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 Totel (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, $35 • S�0
whichever is greater) whichever is greater)
Requ�ts for Electrical Inspection (REI) wfth a fee of $250 or less expire 72 months from the flUng date. The contractor must have the work completed within
the 12 month period or submit another REI that includ� the i�pection 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 stffied: For Department Use Only
Rough - In Inspection(s) Date �
i
Final Inspection
This mateNal can b�
TDD (651) 297-4198.
REI 02 (6/07)
Date
T� ,�o
such as large i
�� ���
,
RECD J U l. U 9 2008
or on a tape. To request, call 1-800-342-6354 (DIAL-DLI) Voice or