P - 75314Minnesota Departrnerrt of Labor and Industry
443 Lafayette'Road North
St. Paul, MA� 55155-4342
Phone: (6��,�'1) 284-5064
TTY/MR�P (651) 297-4198
www.el�tncit�r.state. mn. us
Contractor/Registered
Rough-In Inspectlon R�uir�?
04/09/08 � Contr�actor�n
Address of Inspection — StreE
5576 REGIS DRIVE NE
Owner Name
RON NELSON
(763) 571-1377
WIRE-RITE ELECTRIC CO
ContractoNEmployer Telephone �
(765) 574-9015
Senrice/Power Supply
Servic�//Power Supply
Senrice/Power Supply
New/Extended
�/����
,;�` �-'' �� � ' ��'"T �-' �
�,�� �I� ��u�'� l,��ed ���f�c;��
/er Re uest for Electrical Ins ection
y� Single Ins�on Other Than Rough-In: � Ready Now
cdons ContractoNEm lo er Must Schedule All Final Inspections ❑ 1MII Schedule
City/Township County
FRIDLEY ANOKA
REPLACE SERVICE PANEL � INSTALL LOWER BATH
ROOM GFI OUTLET 20 AMP
contractor/Registered Employer Mailing Address
5750 MADISON ST NE FRIDLEY MN 554532-5639
ContractoNEmployer E-mail Address Electrical Utility
Contractor License Number
CA 1958
Fee Calculation
0 — 400 ampere @ $35
401 — 800 ampere @ $60
Above 800 ampere � $100
Up To 200 A( )@$6 Each
Feeders/Circuit� Above 200 A ( )@$15 Each
Reconnected Feeders/Circuits ( 16 ) @ $2 Each
Manufactured Home Park Lot Supply ( )�$35 Each
Recreational Vehicle Site Suonlv Eauioment
Job/Project Contact Person
PERRY 612.366.5697
Technology System Devic�s (
Separate Bonding Inspections for :
Equipotential Planes (
Center Pivot Irrigation Booms (
Plus ( � Electrical
Luminaire Retrofit Madfications (
) @ 75¢ Each
�a Pools and
) � $35 Each
i�$5 Each
) @ 25¢ Each
Concrete-Encased Electrode InsRection ( ) @ $35 Each
Investigative Fee $70 Or The Total Inspection Fee,
ee (
Miles
of
Circuits Ori inatin in the E ui ment $6 Each
Street, Parking Lot, Lighting Standard ( )@$5 Each �81' 6OO VOItS — Add the combir�ed seM�/power supply and feederldrta�it fee to
reswt m do„b�e ure reqwar ree (does rrot epp�y ro e�ectric elgn and a,tih�e ughtlns)
Transformers Up to 10 kva ( )@$15 Each � ) New Muiti-Family Dwellings @$70 Each
With Up To 20 FeederslCircuits
Transformers Over 10 kva ( )@$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
6 Each
Electric Signs and OuUine Lighting TOtal (the f� calculated above or $35 multiplied
Transformers/Power Su lies $5 Each by the number of r�uired inspection tri s,
whichever is greater) p $67�
Requ�ts for Electricai Inspectlon (REI) wlth a fee of $250 or less expire 12 morKhs from the flling date. The contractorlemployer muat have the work
completed within the 12 month peMod or submit another REI that includes the inspectlon fee for the uneompleted vrork. Ir�pecUon fees do not carry over
from one REI to another.
A service cha e of $30 will be added for all dishonored checks.
I hereby certify that I inspe�ted the electrical installation herein on the date,s stat�: For Depertment Use Only
Rough — In Inspection(s) Date
Thls material can be made avallable in
TDD (651) 297�198.
REI 03 (6/07}
o�e RECD A P R 0 9 2008
: � �� a��- Ob �
:h large pr�nt, Brallle or on a tepe. To request, call 1-8Q0-342-5
or