P - 75144� . ,
Minnesota De�artrnerit of Labor and Industry � '
443 Lafayette I�es�d North
St. Paul, MN, 55155-4342 - . : � �� � ' /� (\ I ( f] ( ,�
Phone: (6 ,��284-5064 . .. � �� V `' j' 1, Y�
TTY/M R (651) 297-4198 • , • .
www:e ricity.state.mn.us � . .' � . �..
Co #ractor Re uest for Electiricar Ins ection — One Famil. Qwellin /Associated Structure
Date Rough-In Inspection Required?' Q Yes; • Single,Inspection.Other Than Rough-In: � Ready Now
4-20-08 Contractor Must ScFredule All Rou h-1n Ins ections Contra�tor Must Schedule All Final Ins ections ✓Q Will Schedule
Address of Inspection — Street ... •� • CitylTownship County
480 RICE CREEK BLVD NE. FRIDLEY ANOKA
Owner Name . . � � . Project�Descriptiori . .
JIM & BETH SARVE ��� �� � . AIR COND $ ATTJC BLOV1/ER - LIGHT IN ATTIC & GFI
Owner Telephone Number(s) = Include Area Code(s) , .. � . . . .
(763) 574-2Q51 � . :. .
Contractor Name' � , Corrtractor.Mailing Address, . - . . .
B&K ELECTRIG.OF TH� TWIN CITIE 1749 JONES LANE MQUND MN 55364
Contractor Telephone Number Cont�actor �-rnail �4ddress �. ElectriCal Utili.ty
(952) 495-0444 �. . . .
Co cto Authori d Signature ; Cvntraetor License Number Job/Project Contact Person
� '. CA02923��. �. . � � KEITH 612-532-4550
� . .. � � �Fee�Calculation �
� New Home or Associated Structure �E�tisting Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0- 400 ampere @$35 �; New Senrice/Power:Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 8Q0 :arripere Ldi�$6.0' '. NeVV Seryice/Power.Supply . 401— 800 ampere @$60
New Dwelling Feeders/Circuits .. . "�• ' :..., � '. New/F�ftended Feeders7Circuits — Up to 15 Feeders/Circuits
U to 30 Feeders/Circuits -'$100� �" � 3 � Feeders%Circuits' $6 Each or 16 to 30 $100 �� 8
New Home — More than 30 Feeders/Circuits (in addition to • New/Extended Feeders/Circuits — More Than 34 Feeders/Circuits
above . Feeders/CirCUits U To 200 A $6 Each � � � Feetlers/Circuits U to 200 A $6 Each
Other (Specity) Reconnected.Fesders/Circuits
� ' Feeders/Circuits $2 Each
Detached Garage .or Other Associated Structure Detached Garage or Other Associated Structure
NewService/PowerSupply � 0=400 amp@re.� $3b. .,• New'Senric:e/Pdwer.Supply 0-400 ampere @$35
New Feeders/Circuits ( � ):,@ $6 Each : � New/Extenited Feeders/CircUits ( ) @ $6 Each
Other (Specify) . . : :: • . .
• , Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Specify) ' Other (Specify}
Total (the fee calcufated above or$35 multipl[e.d .. � •'fO�a1•�(the fee: Ealc�lated above or $35 multiplied �
by the number of required inspection trips, .� bythe number ofr�uired�inspection trips, �
whichever is greater) • : . .. . whichever is greater)
Requests for ElecUical Inspectlon (REI) with a fee of $250 or less explre 12 months from tFie filPng date. The contractor must have the work completed within
the 12 month period or submit anofherREf that includes the inspection fee for the uncompleted work. Inspection fees do not carry over from one REI to
' • anather .
A servfc�e eharge of$30 vril) be added for all dishortored•checks'.
I hereby csrtify that i inspected the electrical installation herein on the dates stated: For Departrnent Use Only
Rough — In Inspection(s) � ' Date '
^,�_ Y- � : � �� - d.� �.� �
Final Inspection . ' .Date '
. � . � ��. z 2� d � � . .� I�D �:PR 21� 2008.
This mater(al c made available in different forms;.�such as large prlrrt, Braiite or on a tape. To request, caU 1-800-342-5354 (DIAL-DLI) Voice or
TDD (657) 297�4198. •
REI 02 (6/07) • . . ': • .