P - 75708Minnesota Depa nt of Labor and Industry
443 Lafayette Ro North
St. Paul, MN 5 5-4342
Phone: (651) 5064
TfY/MRS: (6 ) 297-4198
www.electrici .state.mn.us
Contractor Re uest for Electrical I
Date Rough-In Inspection Required?
08/15/2007 Contractor Must Schedule All Roual
Address of Inspection — Street
1406 WEST DANUBE ROAD
Owner Name
ALEX GONSALVES
Owner Telephone Number(s) — Inclu
(763) 574-0435
Contractor Name
CENTERPOINT ENERGY
Contractor Telephone Number
(763�757-6202� ,�, �, �
o�� � C�l�l�
i��� U �U�7 � O 2007
s ection — One Famil Dwellin /Assc
❑ Yes Single Inspection Other Than Rough-In:
n Insqections Contractor Must Schedule All Final Insp
City/Township County
FRIDLEY ANOKA
Project Description
WIRE/ RECONNECT AIR CONDITIONER
Structure
] Ready Now
� Will Schedule
Contractor Mailing Address
9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
Contractor E-mail Address Electrical Utility
joann.zinken@CenterPointEnergy
Contractor License Number Job/Project Contact Person
CA01796 JOANN ZINKEN
Fee Calculation
New Home or Associated Structure
New Dwelling Service/Power Supply 0— 400 ampere @$35
New Dwelling Service/Power Supply 401 — 800 ampere @$60
Up to 30 Feeders/Circuits - $100
— More than 30 Feeders/Circuits (in addition to
1 Feeders/Circuits U� To 200 A Ca) $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
Other (SaeciN)
(Specify)
0 — 400 ampere � $35
( ) @ $6 Each
Existing Home/Structure Remodel or Addition
New Service/Power Supply
New Service/Power Supply
0 — 400 ampere @ $35
401 — 800 ampere � $60
ts — Up to 15 Feeders/Circuits
$6 Each or 16 to 30 @$100
— More Than 30 Feeders/Circui
ts Uo to 200 A Cc� $6 Each
( ) Feeders/Circuits @ $2 Each �
Detached Garage or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
NewlExtended Feeders/Circuits ( ) @ $6 Each
Reconnected Feeders/Circuits ( �)@$2 Each I $2
Other (Saecifi�)
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, �
whichever is greater) whichever is greater) �/
Requesffi for Electrlcal Inspectlon (REI) wlth a fee of $250 or less expire 12 months from the filing date. The contractor must have the work completed withln
the 12 month period or submft another REI that Includes the inspecUon fee for the uncompleted work. Inspectfon fees do not carry over from one REI to
another.
A service charge of $30 will � added for all dishonored checks.
i►,Arwhvi certifv that 1 insoeded the elecVical installation herein on the dates stated: For Department Use Only
Rough — In Inspection(s)
TDD (651) 287�L198.
REI 02 (6/0�
Date
Date
_ --`r� ���
forms, suc as large print, Brallle or on a tape. To request, call 1-500-342-5354 (DIAL-DLI) Volce or