P - 76825Minnesota Departm
443 Lafayettie Road
St. Paul, MN 5515j
Phone: (651) 28g�
TTY/MRS: (651��
Labor and Industry
-4198
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[��� 12 2007
Contracfor R uest for Electrical Ins ction — One Famil Dwellin /Associated Structure
Date Rough-In Inspec6on Required? Yes Single Inspedion OtherThan Rough-In: Ready Now
12/10/07 �
Contrador Must Schedule All Rou h-In In 'ons ConVactor Must Sdiedule All Final In dions �/ Will Schedule
Address of Inspedion — Street City/Township County
6532 PIERCE ST NE FRIDLEY ANOKA
DAVE HITCHCOCK
Owner Te�ephone Number(s) —
(612) 382-3873
WIRING REPAIR
SHORTSTOP ELECTRIC 16481 FLINTWOOD ST NW ANDOVER, MN 55304
Contrado� Telephone Number Contractor E-mail Address Electrical Utility
ZG3'�`�3��7%I Z shortstopelectric@comcast.net
Co�n�t" ctor Authorized Signature Contrador License Number Job/Project Contact Person
!�/,�Z�,�� l~ 01670 BOB BOYUM
Fee Calculation
Ne�w Home or Associated Structure Existing HomelStructure Remodel or Addition
New Dwelling Servioe/Power Suppy 0— 400 ampere � 335 New ServioelPower Suppy o— 400 ampere � S35
New Dwelling Servioe/Povrer Suppy 401 — 800 ampere Q E60 New Service/Power Supply 401 — 800 arnpere �$60
New Dwelling FeederslCircuits New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits
- Uo to 30 Feefiers/CireuRa - S1 W (� 1�' ?�eederalCiraiits � S8 EaCh or t6 to 30 - s100
— More than 30
To 200 A
Other (Specify)
Detached Garage or Other Associated Structure
New Servioe/Power Suppy 0—�00 ampere � 335
New Feeders/Circuits ( ) � 36 Each
Olher (SDeciH)
FeedersrCircuils — More Than 30 FeederslCi
) Feeders/Circuits Up to 200 A� S6 Each
Feeders/Circuits
( ) Feeders/Circuifs � 32 Each I
Detached Garage or Other Associated Structure
New Servioe/Power Supply 0— 400 ampere � S35
New/Extended FeederslCircuit,s ( ) � 36 Each
Reconneded FeederslCircuits ( ) � E2 Each
Other (Saecifv)
'. . !
TOtdl (the fee cak�lated above or 535 muldplied TOt81(the fee calwlated above or a35 multiplied � �
by the number of required inspedion trips, by the number of required inspection trips, Q^--
whichever is greater) whichever is greater)
Requeats for Elestrical InspecUon IREI) wkh a fee of i250 or le� expke 12 morkfis from the fllMg daEe. The condactor must have the work complsted wkhin
the 12 month perlod or submk another REI tl�at fncludes fhe kapsation fes for the uncompleted wak. Inspsctlon fees do not carry over trom one REI to
another.
A service charge of i30 wfll bs added for all dishorarYd checks.
1 hereby certify that I inspected the electripl installation herein o� the dates stated: For Departrnent Use Only
Rough — In Inspec�ion(s) Date
L �/�. /� �1
This mabeAal can be made avaNable in dilFsreM fortris, such as large prii
TDD (657) 297■t198.
REI 02 (6/07)
or on a tape. To request,
�aw�-v�q vace or