P - 75585Minnesota Department of Labor and Industry
443 Lafayette Road North
St. Paul, M�V 55155-4342
Phone: (6 '' ) 284-5064
TTY/MR (651)297-4198
www.e ricity.state.mn.us
Contractor Re uest for Electrical In
Date Rough-In Inspection Required?
09/02/2008 �ntractor Must Schedule All Rou h-I
Address of Inspection — Street
7454 TAYLOR ST NE
Owner Name
ALL AMERICAN HOMES
Owner Telephone Number(s) — Include Area Code(s)
Contractor Name
JNK ELECTRIC
(612)
s ection — One Famil Dwellin /Associated Structure
❑ Yes Single Inspection Other Than Rough-In: ✓� Ready Now
n Ins ections Contractor Must Schedule All Final Inspections ❑ Will Schedule
FRIDLEY � qNOF(q
Project Description
INSTALL 100 AMP FEEDER
Contractor Mailing Address
321 QUINCY ST NE; MPLS MN 55413
Contractor E-mail Address
1154 XCEL
uthorized Signature Contractor License Number Job/Project Contact Person
/ CA00905 JOHN KOURI
Fee Calculation
New Home or Associated Structure Existing Home/Structure Remodel or Addition
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Dwelling Feeders/Circuits
Up to 30 Feeders/Circuits - $100
New Home — More than 30 Feeders/Circuits (in addiGon to
above) ( ) Feeders/Circuits Up To 200 A C� $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits
(SPecifY)
( ) @ $6 Each
New Service/Power Supply
New Service/Power Supply
1
0 — 400 ampere @ $35
401 — 800 ampere @ $60
$6 Each or 16 to 30 @$100
— More Than 30 Feeders/Circu
ts Up to 200 A C� $6 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
$6
Tota) (the fee calculated above or $35 multiplied Total (the fee calculated above or $35 multiplied
by the number of required inspection trips, by the number of required inspection trips, $35 ,�
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) wfth a fee of $250 or less expire 12 months from the flling date. The contractor must have the work completed wtthin
the 12 month period or submit another REI that Includes the Inspection fee for the uncompleted work. Irispectlon fees do not carry over from one REI to
another.
A service charge of $30 wlll be added for all dishonored checks.
I hereby certity that I inspected the electrical ins[allation herein on the dates stated: F� D� i�� �Only
Rough — In Inspection(s) Date
��
Finallnspection Date� �� �� SEP 1 O 200�
/"�� �i %� n .
� �U
This material can b� made available in dffferent forms, suc as large prl` Braille or on a tape. To request, call
TDD (657) 287-4198.
REI 02 (6/07)
or