P - 76846Minnesota Depa ent of Labor and Industry
443 Lafayette d North
St. Paul, MN 155-4342
Phone: (651 84-5064
TfY/MRS: 51) 297-4198
www.elect ity.state.mn.us
Contractor Re uest for Electrical I
Date Rough-In Inspection Required?
09/07/2007 Contractor Must Schedule All Rou I
Address of Inspection — Street
6300 STARLITE BLVD NE
Owner Name
NORRIS KNUTSON
Owner Telephone Number(s) — Include Area Code(s)
(763) 571-2932
Contractor Name
CENTERPOINT ENERGY
(763) 757-6202
Signature
�REC'D S E P 10 2007
�e�� - �i��3
tion — One Famil Dwelli
Yes Single Inspection Other Tha
>ociated Structure
n� ❑ Ready Now
Contractor Must Schedule All Final Ins ections [✓� Will Schedule
City/Township Counry
FRIDLEY ANOKA
Project Description
WIRE/ RECONNECT FURNACEA ND AIR
CONDITIONER
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrica! Utility
joann.zinken@CenterPointEnergy
Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
New�or Associated Structure
New Dwelling Service/Power Supply 0— 400 am— jf2rc� $35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
Ale... R...ell:..n Ces.de.e./�`7.n� dM. ... . _ - _ ..
New Home — More than 30
above) ( ) Feeders
Other (Specify)
Existing Home/Structure Remodel or Addition
New Service/Power Supply
New Service/Power Supply
0 — 400 ampere @ $35
401 — 800 ampere @ $60
—Upto15
to 30 Feeders/Circuits -$100 Feeders/Circuits $6 Each or 16 to 30 $100
�rs/Circuits (in addition to New/Extended Feeders/Circuits — More Than 30 Feeders/Circuits
its U To 200 A $6 Each Feeders/Circuits U to 200 A $6 Each
Reconnected Feeders/Circuits
Feeders/Circuits Ca� $2 Each � $4
Detached Garage or Other Associated Structure I Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other (Specify)
TOtal (the fee calculated above or $35 multiplied
by the number of required inspection trips,
whichever is areaterl
New Service/Power Supply 0— 400 ampere @$35
New/Extended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Specify)
TOt81 (the fee calculated above or $35 multiplied � �p
by the number of required inspection trips, ��
whichever is greater) �
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The contrector must have the work completed within
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.
A service charge of E30 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated:
Rough — In Inspection(s) Date
This material can be made
TDD (651) 297-4198.
REI 02 (6/07)
Date
-�7 `G
i as large print,
or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or