P - 75236Minnesota De
443 Lafayette
St. Paul, MN
Phone: (651)
TTY/MRS: (6
of Labor and Industry
� ) 297-4198
.state.mn.us
Contra�tor Re uest for Etectrical Ins
Date Rough-In Inspection Required?
9/11/2007 Contractor Must Schedule All Rou h-In
Address of Inspection — Street
5662 WEST BAVARIAN PASS NE
JON ENGEBRETSON
Owner Telephone Number(s) — Include Are
(763) 502-9467 (612) 240-1626
Contractor Name
CENTERPOINT ENERGY
Contractor Telephone Number
(763) 757-6202
Code(s)
��� �/���
I��'p SEP 17 2001
tion — One Famil Dwellin /Associated Structure
Yes Single Inspection Other Than Rough-In: ❑ Ready Now
;ctions Contractor Must Schedule All Final Ins ections �❑ Will Schedule
CitylTownship County
FRIDLEY ANOKA
Project Description � �
WIRE/ RECONNECT FURNACE AND AI ��
CONDITIONER
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utility
joann.zinken@CenterPointEnergy CONNEXUS
Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
or Associated Structure
New Dwelling Senrice/Power Supply 0— pe[@�$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
New Home —
Feeders/Circuits
Up to 30 Feeders/Circuits - $100
Jlore than 30 Feeders/Circuits (in addition to
1 Feeders/Circuits Uo To 200 A CD $6 Each
Other (Spec'rfy)
Detached Garage or Other Associated Structure
New Servic�/Power Supply 0— 400 ampere @$35
New Feeders/Circuits
Other (Saec'rfv)
(Specify)
( ) @ $6 Each
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
New/Ezfended FeederslCircuits - Up to 15 Feede ro its
( ) Feeders/Circuits @$6 Each or 16 to 30 �$100
New/Extended Feeders/Circuits — More Than 30 Feeders/Circui
( ) Feeders/Circuits Up to 200 A�$6 Each
Reconnected Feeders/Circuits
( 2 ) 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 ,
$4
��
Total (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, � s�
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the £Iing date. The contractor must have the work completed within
the 12 month perlod or subm(t another REI that Includes the InspecUon fee for the uncompleted work. Inspectlon fees do not carry over from one REI to
another.
A service charge of $30 will be added for all dishonored checks.
I hereby certity that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s) Date
Thls material can bi
TDD (651) 297�4198.
REI 02 (6/07)
Date
_ _l�, _6
forms, such as larg
or on a tape. To request,
Voice or