P - 76932Minnesota Depa nt of Labor and Industry
443 Lafayette d North
St. Paul, MN 155-4342
Phone: (65 84-5064
1TY/MRS' S1) 297-4198
www.ele icity.state.mn.us
Con ractor Re uest for Electrical Ins
Date Rough-In Inspection Required?
07/11 /2007 Contractor Must Schedule All Rou h-In I
Address of tnspection — Street
175 SYLVAN LANE NE
Owner Name
E W WETTERBERG
Owner Telephone Number(s) — Include Area Code(s)
(763) 571-3748
REC'D J U L 16 2001
�G�� ����� I
tion - One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: ✓ Ready Now
;ctions Contractor Must Schedule All Finai Inspections ❑ Will Schedule
FRIDLEY
ANOKA
WIRE/RECONNECT FURNACE AND AI j�
CONDITIONER
Contractor Name Contractor Mailing Address
CENTERPOINT ENERGY 9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor Tefephone Number Contractor E-mail Address Electrical Utility
(763) 757-6202 joann.zinken@centerpointenergy co
at�7te Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Suppiy 0— 400 ampere @$35 New Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — S00 ampere @$60 New Service/Power Supply 401 — 800 ampere @$60
ew Dwe ing e ers ircuits New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits
Up to 30 Feeders/Circuits -
— More than 30 Feeders/Circuits (in addition to
200 A
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New �eeders/Circuits ( ) @ $6 Each
100
— More Than 30
'ts Uo to 200 A i
( ) Feeders/Circuits $2 Each �
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere �$35
New/Extended reeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( ) @ $2 Each
Other (Specify)
,
ar
Total (the fee calculated above or $35 multiplied l jI}�Otal (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 Inspection (REI) wkh a fee of 5250 or less expire 12 months from the flling date. The contrector muat have the work completed wkhin
the 12 month period or submit another REI that Includes the InspecUon fee for the uncompleted work. Inspection fees do not carry over from one REI to �
another.
A service charge of S30 will be added for all dfahonored checks.
I hereby certiry that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
Final
Tnis material can be made avallable In dlfferent forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or
TDD (657) 297-4198.
REI 02 (6/07)