P - 76719Minnesota Department of Labor and Industry
443 Lafayette Road North
St. Paul, MN 5155-4342
Phone: (651 284-5064
TTY/MRS: 51) 297-4198
www.ele ity.state.mn.us
Contractor/Re istered Em
Date Rough-In Inspection Required?
1/16/08 ContractoNEm lo er Must Schedule All Rou h-Ir
Address of Inspection - Street
841 OVERTON DRIVE NE
Owner Name
STACI MATTHEWS
Owner Telephone Number(s) - Include Area Code(s)
(612) 636-2425
Employer
COLLINS
(651) 224-2833
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RECD J A N 2 5 2008
rer Re uest for Electrical In:
Yes Single Inspection Other Than Rough-In:
�tions ContractoNEmolover Must Schedule All
City/Township
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WIRE GAS FIREPLACE
ANOKA
I278 STATE STREET ST PAUL MN 55107
Number ContractodEmployer E-mail Address Electrical Utility
Signature Contractor License Number
�n � CA00406
Fee Calculation
Service/Power Supply 0- 400 ampere @$35
Service/Power Supply 401 - 800 ampere @$60
Service/Povuer Supply Above 800 ampere @$100
New/Extended Feeders/Circuits Up To 200 A( �)(a� $6 Each
Feeders/Circuits Above 200 A ( )@$15 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Manufactured Home Park Lot Supply ( ) Q$35 Each
Recreational Vehicle Site Supply Equipment
{ ) Circuits Originating in the Equipment $6 Each
Technology System Devices (
Center Pivot Irrigation Booms (
Pfus - -- EteCtric�i
$6 luminaire Retrofit Modifications (
Ready Now
Will Schedule
POSTf
D
) Q 75¢ Each
g Pools and
) C� $35 Each
�its @ $5 Each
) @ 25¢ Each
Concrete-Encased Electrode Inspection ( ) @ $35 Each
Investigative Fee $70 Or The Total Inspection Fee,
Whichever Is Greater Up To $1,000
Special Inspection Fee ( ) Hours aQ $80 Per Hour
Plus ( ) Miles � The IRS Mileape Rate of (
Street, Parking Lot, Lighting Standard ( )@$5 Each Over 600 Volts - naa v,e comu�nea seMCe�poWer suppy a�a reeaen���a,a r� co
result in double Me regular fee (does not apply to electric sign and outline lighting)
Transformers Up to 10 kva ( )@$15 Each � ) New Multi-Family Dwellings @$70 Each
With Up To 20 Feeders/Circuits
Transformers Over 10 kva ( )@$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
6 Each
Electric Signs and Outline Lighting TOt81(the fee calculated above or $35 multiplied
Transformers/Power Su lies $5 Each by the number of required inspection trips,
whichever is greater) $35.50
Requests for Electrlcal Inspection (REI) with a fee of 5250 or less expire 12 months from the filing date. The contractor/employer must have the work
completed within the 12 month period or submit another REI that includes the inapection fee for the uncompleted work. Inspectlon fees do not carry over
from one REI to another.
A servlce char e of E30 will be added for all dishonored checks.
I hereby certify that l inspected the electrical installation herein on the dates stated: For Department U8e Only
Rough - In Inspection(s) Date
Final I
� ms matenal can b�
TDD (651) 297�798.
REI 03 (6/07)
Date �
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s �n different forms, such as large print, Braille or on a tape. To request,
or