P - 76676Minnesota Department of Labor and Industry
443 Lafayette Ro d North
St. Paul, MN 5 55-4342
Phone: (651) 4-5064
TTY/MRS: ( 1) 297-4198
www.electr' y.state.mn.us
Contractor/Re istered E
Date Rough-In Inspection Required?
10/30/07 ConVactodEm lo er Must Schedule All Rou
Address of Inspection — Street
7170 RIVERVIEW TERRACE
Owner Name
JOHN BERG
Owner Telephone Number(s) — Include Area Code(s)
(763) 572-9441
Yes
o�`��o��
�V�� �� �
REC'D N�v 1 2001
uest for Electrical Ins ection
�le Inspecbon Other Than Rough-In: Ready Now
tractoNEmolover Must Schedule All Final Insoections n Will Schedule
FRIDLEY
Project Description
WIRE GAS FIREPLACE
ContractodRegistered Employer Name ContractodRegistered Employer Mailing Address
COLLINS 278 STATE STREET ST PAUL MN 55107
ContractodEmployer Telephone Number ContractodEmployer E-mail Address Electrica
- - — (fi51 j 2z�=z$�ss-- ------- ---
Contractor/Employer Authorized Signature Contractor License Number Job/Proj
� �j �' CA00406
Fee Calculation
Service/Power Supply 0— 400 ampere �$35 Technology System Devices (
Separate Bonding Inspections for
Service/Power Supply 401 — 800 ampere @$60
E ui tential Planes
Center Pivot Irrigation Booms (
Service/Power Suppiy Above 800 ampere @$100 .
Plt!s � EIeC+rical
County
ANOKA
POSTf D
) � 75¢ Each
g Pools and
) Cc� $35 Each
New/Extended Feeders/Circuits Up To 200 A( �)@$6 Each $6 Luminaire Retrofit Modifications ( )� 25¢ Each
Feeders/Circuits Above 200 A ( ) Q$15 Each Concrete-Encased Electrode Inspection ( )@ a35 Each
Reconnected Feeders/Circuits InvestigaGve Fee $70 Or The Total Inspection Fee,
( ) @ $2 Each
Whichever Is Greater U To $1,000
Special Inspection Fee ( ) Hours @$80 Per Hour
Manufactured Home Park Lot Supply ( )@$35 Each
Plus Miles The IRS Milea e Rate of
Recreational Vehicle Site Supply Equipment Other
Circuits Ori inaGn in the E ui ment $6 Each
Street, Parking Lot, Ligh6ng Standard ( )@$5 Each OV@� F)OO VOItS — Add the combined servic�/power supply and feeder/circuit fee to
resutt in double the regular tee (does not apply to electric si� and atline lightlng)
Transformers Up to 10 kva ( )�$15 Each � ) New Multi-Family Dwellings @$70 Each
With Up To 20 Feeders/Circuits
Transformers Over 10 kva ( ) Q$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
6 Each
Electric Signs and Outline Lighting TOtal (the fee calculated above or $35 multiplied `3�5--�
Transformers/Power Su lies $5 Each by the number of required inspecUon trips, ��
whichever is greater)
Requests for Electrical Inspectio� (REI) with a fee of 5250 or Iess expire 12 months from the filing date. The contractor/empioyer must have the work
completed within the 12 month period or submit another REI that includes the inspectlon fee for the u�completed work. Inspection fees do not carry over
from one REI to another.
A service char e of S30 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
l��F �4"' l t�� `%
�al inspection � 7 Date
_ ��--c� �
This material can be made available in different forms, such as large p�tnt, Braille or on a tape. To request, call 1-800�42-5354 (DIAL-DLI) Voice or
TDD (651) 297-4198.
REI 03 (6/07)