P - 76888Minnesot epartment of Labor and Industry
443 Lafa tte Road North
St. Pau N 55155-4342
Phone� 651) 284-5064
TTY/ S: (651) 297-4198
www. ectricity.state.mn.us
Contractor Re uest for Electrical I
Date Rough-In Inspection Required?
09/24/2007 Contractor Must Schedule All Rou I
Address of Inspection — Street
571 RICE CREEK BLVD NE
Owner Name
onTRirk nnrrni n Fv
Owner Telephone Number(s) - Include Area
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Contractor Name
CENTERPOINT ENERGY
Contractor Telephone Number
(763) 757-6202
Authorized Siqnature
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tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: � Ready Now
�ctions Contractor Must Schedule All Final Ins ections ✓Q Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description
WIRE/ RECONNECT FURNAEA ND AIR
CONDITIONER
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utility
joann.zinken@CenterPointEnergy
Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
or Associated Structure
Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supp�ly 0 re @$35 I I New Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
Up to 30 Feeders/Circuits - $100
New Home — More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A@$6 Each
Other (Specify)
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other
New Service/Power Supply 401 — 800 ampere @$60
flew/Extended Feeders/Circuits — Up Co 15 Feeders/Clrcuits
Feeders/Circuits $6 Each or 16 to 30 $100
New/Extended Feeders/Circuits — More Than 30 Feeders/Circuits
Feeders/Circuits U to 200 A $6 Each
Reconnected Feeders/Circuits
2 Feeders/Circuits $2 Each $4
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
Other (Specify)
Total (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, 3� �
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The contractor must have the work completed within
the 12 month period or submit another REI that includes the inspection fee for the uncompleted work. Inspection fees do not carry over from one REI to
another.
A service charge of E30 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
This material can be
TDD (651) 297-4198.
REI 02 (6/07)
Date
_ �----_ ��: r y < �
ble in different forms, such as large prir
or on a tape. To request,
(DIAL-DLI) VOIC@ O�