P - 75495Minnesota Depa , nt of Labor and Industry
443 Lafayette R North
St. Paul, MN � 55-4342
Phone: (65 84-5Q64
TTY/MRS: 1) 297-4198
www.el ' .state.mn.us
Contractor Re uest for Electrical Ins ection — One Famil Dwellin lAssociated Structure
Date Rough-In Inspedion Required? ❑ Yes Single Insper.tion Other Than Rough-In: � Read Now
Y
S/20/08 Contrador Must Schedule All Rou h-In Ins 'ons Contrador Must Schedule All Finai In 'ons � Will Schedule
Address of Insp�ion - Str�t City/Township Courrty
6120 STARLITE BLVD FRIDLEY ANOKA
Owner Name Project Desc�iption
RANDY BENEDICT 100A SERVICE CHANGE OUT, ADD MICROWAVE
Ov+mer Telephone Number(s) - Indude Area Code(s) CIRCUIT
(763) 5741561
Contractor Name Corrtractor Mailing Addroess
`� STONEY CREEK ELECTRIC INC 2034138TH AVE NW ANDOVER MN 55304
Contr-ador Telephone Number Contrador E-mail Address Elec�rical Utility
(763) 757-1581 � .�� g'D -- � EXCELL
_ - -- - Coa�cad - - Jobt�noject_Cantac�Persoa. - -
� � CA03665 AARON
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0- 400 ampere @$35 New Servi�/Pourer Supply �O y'0 - 400 ampere @$35 $35
New Dwelling Service/Power Supply 401 - 800 ampere @$60 Plew Service/Power Supply 401 - 800 ampere @$60
New Dwelling Fe�ersJCircuits Newl6dended FeederslCircuits - Up to 15 Feeders/Circuiffi
- - - - - Feeders/ � - � Fee�er�Cirpiiis EaGh t3r-] 6 $s - -- -� - -
New Home - More than 30 F�ders/Circuits (in addidon to ` New/Extertded Feeders/Circuits - More Than 30 Fcede�s/Ctrc�its
above Feeders/Circuits U To 200 A $6 Each � F�de�slCi�its U to 200 A $6 Each
Other (Specvfjr) R�nneded Feeders/Circuits
16 F�ders/circui� $2 Eac� $32
� Detached Garage or Other Associated Structure Detached Garage or Other Associated Strvcture
New Service/Power Supply 0- 4Q0 ampere @$35 New Senrioe/Power Supply 0- 400 ampere @$35
New Feeders/Circxiits ( ) @ $6 Each New/Extended Feeders/Circuits ( } @ $6 Eac�
_ Other�SQecify)_-- -- -- -- - - -
�onne ed"��er�-ircuifs'.!_� —�.��cfi -- - - - � _ —
Other (SP�Y) Other (Speqfv)
Total (the fee calculated above or $35 multiplied Total (the fe.e calailated above or $35 multiplied
by the number of required inspection trips, by the number of requir� ins on
whichever is reater � �, $73
9 ) whichever is greater)
Reques6s for Electricallr�pecUan (REn wHh a fee of SZbO or less expire 12 mo� from f� date. 71� co»�or must i�re Ure wark compleLed wHhl �?-
Me 12 moMh period or submlt ar�her R�1 tl�at Inctudes tl�e tr�tlan fee i� the pt�d worlc. lnspeulon fe� � rtot
anather. �I► over irom are �J to ;�`
A 8erviCe cl�arge ot f30 will b0 added all dishonoied Checlts.
I herebY certifp that I ir�pected the etedrical ir�stailatian h�em on the daUe.4 slated: .��� o���nt Use Only .
Rough - In Inspedion(s) Date -�
Final Inspedion Date� �[� � � � � $ �oOQ
1\L V
�� f
Thls matarial can be I le in dtHerern Torms, such laree
TDD (669) 297-4188.
REI 02 (6/0�
or on a mpe. To request, ca11 7-8��42-53b4 (DIAL-0LI) Voice or