P - 75410Minnesota Dep,�rtrnent of Labor and Industry
443 Lafayette,�toad North
St. Paul, MN,;�i5155-4342 � Q
Phone: (65 284-5064 O� � � D
TTY/MRS: 51) 297-4198
www.ele ity.state.mn.us
Cont ctor Re ues# for Electrical I
Date Rough-In Inspection Required?
10/15/2008 Contractor Must Schedule All Rougl
Address of InspecUon — SVe�
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Owner Name
EDSON FUGELSTAD
Owner Telephone Number(s) —
(763) 571-5751
Contractor Name
CENTERPOINT ENERGY
Contractor Telephone Number
(763) 757-6202
Area
nl
tion — One Famil / Dwellir
Yes Single Inspection Other Than
�ctions Contractor Must Schedule All
�ociated Structure
�� ❑ Ready Now
:nactions n Will Schedule
C'dy/Township County
FRIDLEY ANOKA
Project Description
WIRE/ RECONNECT FURNACE AND 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
Home or Associated Structure
�
New Dwelling Seroice/Power Supply ere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Dwellina Feeders/Circuits • �
Up to 30 Fesders/Circuits -
New Home — More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A@$6 Ea�
Other (Saecify)
npta�h�d Garaae or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits
Other (Specify)
Other (Specify)
( ) @ $6 Each
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
- NewrJ€xtersdeci �eeders/Circui4s— lfp to 95 FaedersJCir�c�its
Feeders/Circuits $6 Each or 16 to 30 $100
New/Extended Feeders/Circuits — More Than 30 Feeders/Circufts
I 1 Feeders/Circuits U� to 200 A(cD $6 Each
( 2 ) Feeders/Circuits @ $2 Each �
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 Dr $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips,
whichever is greater) whichever is greater)
Requests for Electrical Inspeetlon' (REI) with a fee of $250 or less expire 12 months from the filing date. The coritractor muat have the work cort
the 12 month period or submft another REI that includes the InspecUon fee for the uncompleted work. InspecUon fees do not carry over from
another.
A service charge of $30 will be added for all dlshonored checks.
r- _
I hereby certiTy that I inspeded the electrical installation herein on the dates stated; , For Department Use Only
Rough — In Inspection(s)
0
Date
Final Inspection Date
/`/ /'z-
Thts materlal can ba made avatlable In d(fferent forms, such as lar
TDD (651) 287�188.
REI 02 (6/0�
Z��c� � i�l� !
REC'D OC� 2 � �oA��v
or on a tape. To request, call 1-800-342-
$4
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