P - 75321Minnesota De '' ent of Labor and Industry
443 Lafayett oad North
St. Paul, M . 55155�342
Phone: ( ) 284-5064
TTY/M . (651) 297-4198
www.e ricity.state.mn.us
Contractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
02/26/08 Contractor Must Schedule All Rou h-In
Address of Inspection — Street
5290 SAINT IMIER DRIVE NE
CHAUDHARY SATVEER
�o � Numbe,f(s)�
Contractor Name
SOUTH SIDE
(95?)888-550a
Contractor Authori;
tion — One Famil � Dwelli
Yes Single Inspection Other Tha
�ctions Contractor Must Schedule A
City/Township
FRIDLEY
���%�
Associated Structure
�gh-In: � Ready Now
al Inspections � Will Schedule
County
u�n�si���,�, ��C[�i �
GARAGE/ENTRY ADDITION.
n�r . sc . ��
oiy� Contractor Mailing Address
CT C, INC. 9201 E. BLOOMINGTON FRWY, BLOOMINGTON, MN 55420
Number Contractor E-mail Address , Electrical Utility
Signature Contractor License Number
CA01695
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Dwelling Feeders/C ucri�' ds '
Up to 30 Feeders/Circuits - $10i
New Home — More than 30 Feeders/Circuits (in addition to
above) ( ) Feeders/Circuits Up To 200 A $6 Each
Other (Speciy)
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other
Job/Project Contact
952-292-8419
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
New/F�ctended FeederslCircuits — Up to 15 Feeders/Circu�s
12 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
Reconneded Feeders/Circuits
Detached Garage or Other Associated Structure
New Servics/Power Supply 0-400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
� viai �[ne ree caicwated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspedion trips, by the number of required inspection trips,
whichever is greater) whichever is greater)
Requests for Electrlcal Inspectlon (REI) with a fee of $250 or less explre 12 months from the flling date. The contractor must have the
the 12 month peNod or submft another REI that Inctudes the Inspectlon fee for the uncompleted work. InspecUon fees do not ca
another.
A servlce charge of $30 wtll be added for all dlshonored checks.
I hereby csrtify that I inspected the el�tripl installation herein on the dat tated•
$72
�� 5 U
from one REI to
Rough — In Inspe ' s) � ta es ' � For Departrn O ��� �
�-- -��' �`��—�r'��� �
Final Inspection �--- � Date
Thls materlal can be made
TDD (6b1) 297-4798.
REI 02 (6/07)
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