P - 76750L�, �001 `-�
Minnesota Depa ent of Labor and Industry
443 Lafayette d North
St. Paul, MN 155-4342
Phone: (651 84-5064
TTY/MRS: 1) 297-4198
www.electri y.state.mn.us
Contractor Re uest for Electrical Irfs
Date Rough-In Inspection Required?
12/04/2007 Contractor Must Schedule All Rou h-In
Address of Inspection — Street
830 RICE CREEK TERRACE NE
Owner Name
GENE AND SHIRLEY O'NEIL
tion — One Fami
Yes Single Inspecti
Owner Telephone Number(s) - Include Area Code(s) -
(763) 571-1982
Contractor Name
CENTERPOINT ENERGY
Contractor Telephone Numbe;
(763) 757-6202
Signature
�,��-oa���
RECD D E C- 6 2007
Dwelling/Associated Structure
)ther Than Rough-In: ❑ Ready Now
� Contractor Must Schedule All Final Ins ections n Will Schedule
City/Township County
FRIDLEY ANOKA
Project Description,
WIRE/ RECONNECT FURNACE
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
CA01796
Fee Calculation
Home or Associated Structure
�
New Dwelling Service/Power Supply�p�, @ $35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
1�1..... fl.....11i.... C.....1...../l�i...��i1.. '-_ �r _.. - .__
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
Job/Project Gontact Person
JOANN ZINKEN
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
Feeders/Circuits
( ) Feeders/Circui
Reconnected Feeders/Circuits
� V�.! \V IJ rCCVCIJ/VIII.YII:
6Eachor16to30Caa$100
( 1 ) Feeders/Circuits @ $2 Each I $2
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 SO
by the number of required inspection trips, by the number of required inspection trips, 35�
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 72 months from the filing date. The contractor must have the work completed withi�
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.
� J�/ /-� �� \ �� A service charge of E30 will be added for all dishonored checks.
/ l"
I hereby certify that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
Final Inspection
✓ '
This material can be made available in different forms, such a� large print, Braille or on a tape. To
TDD (651) 297-4798.
REI 02 (6/07)
) Voice or