P - 75142Minnesota Department of Labor and Industry
443 Lafayette Road North
St. Paul, MN 55155-4342
Phone: (651)284-5064
TTY/MRS: (651) 297-d198
www.electricity.state. mn. us
Contractor Re uest for Electrical
Date Rough-In Inspection Required?
5/05/08 Contractor Must Schedule All Rou
Address of Inspection — Street
6131 TRINITY DRIVE NE
Owner Name
Telephone
Contractor Name
BRIGHT SIDE ELECTRIC INC
Contractor Telephone Number
(612) 940-9540 0
tion — One Famil / Dwellin
Yes Single Inspection Other Than
�rtinnc Cnntractor Must SChedule All
FRIDLEY
Project Description
SERVICE CHANGE
Contrador Mailing Address
10039 209 TH AVE NW ELK RIVER MN 55330
Brightsideeletric@yahoo.com
Contractor License Number
CA04661
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Senrice/Power Supply 401 — 800 ampere @$60
New Dwelling Feeders/Circuits
New Home — More than 30
30
Up To
ders/Circuits - $100
(in addition to
)0 A Cc� $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circufts ( ) @ $6 Each
Other (SpeciTy)
County
ANOKA
Structure
] Ready Now
� Will Schedule
Job/Project Contact Person
SCOTT NELSON 612-940-9540
Existing Home/Structure Remodel or Addition
$35 New Service/Power Supply��, � 0— 400 ampere @$35
/
New Service/Power Supply 401 — 800 ampere @$60
New/Extended Feeders/Circuits — Up to 15 FeederslCircuits
Feeders/Circuits $6 Each or 16 to 30 $100
New/Extended Feeders/Circuits — More Than 30 Feeders/Circuits
( 4) Feeders/Circuits Up to 200 A $6 Each
( 15 ) Feeders/Circuits @ $2 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
$24
$30
Tot11(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, $r� _,
whichever is greater) whichever is greater) �
Requests for Electrlcal Inspectlon (REI) wlth a fee of $250 or less explre 12 months from the flling date. The cor►tractor must have the work completed wlthtn ��
the 12 month peNod or subm(t another REI that Includes the Ins�on fee for the uncompleted work. Inspectlon fe� do not carty over from one REI to
another. �� ���
A servlce charge of $30 wlll be added for all dlshonored checks.
I hereby certify that I inspeded the elpctrical installation herein on the dates stated: For Departrnent Use Only
Rough — In Inspection(s) Date
Final Insp�' �� Date
�/�Gr��,J' ��"�'�.--� � �=d $
Thls mateNal can be made avallable In dffferent forms, such as large print,
TDD (661) 297-4198.
REI 02 (6/07)
���—���e�
{��p M AY 19 2008
or on a tape. To requ�t, call 1-800-342•
Q
votce or