P - 75470Minnesota De
443 Lafayette
St. Paul, MN
Phone: (651)
TTY/MRS: (6
:nt of Labor and Industry
North
297-4198
ate.mn.us
r Re uest for Electrical I
Date Rough-In Inspection Required?
08/25/2008 Contractor Must Schedule All Rou I
Address of Inspection — Street
���� �ni�eT nenn in� cnen
Owner Name
KAREN SCHULTZ
Owner Telephone Number(s) — Include Area
(763) 571-1383 (612) 281-9726
;tion — One Famil Dwellin /Associated Structure
Yes Single Inspecction Other Than Rough-In: � Ready Now
:ctions Contractor Must Schedule All Final Insoections n Will Schedule
City/Tovmship County
FRIDLEY ANOKA
Project Description
WIRE/ RECONNECT AIR CONDITIONER
�`�l�e� / ��d J
�
CENTERPOINT ENERGY I 9320 EVERGREEN BLVD NW SUITE B COON RAPIDS, MN 55433
(763) 757-6202 joann.zinken@CenterPointEnergy
Contra or Authorized Signature Contractor License Number
CA01796
Fee Calculation
�
New Dwelling Service/Power
or Associated Structure
@ $35
-- - - —.
New Dwelling Service/Power Supply 401 — 800 ampere @$60
Dwelling
Up to 30 Feeders/Circuits - $'
— More than 30 Feeders/Circuits (in addition to
) Feeders/Circuits Uu To 200 A Ca� $6 Each
Detached Garaqe or Other Associated Structure
New Service/Power Supply 0— 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other (Specify)
Job/Project Contact Person
JOANN ZINKEN
Existing Home/Structure Remodel or Addition
New Service/Power Supply 0— 400 ampere @$35
New Service/Power Supply 401 — 800 ampere @$60
New/Extended Feeders/Circuits — Up to 15 Feeders/Circuits
Feeders/Circuits $6 Each or 16 to 30 $100
New/Extended Feeders/Circuits — More Than 30 Feeders/Circuits
( ) Feeders/Circuits Up to 200 A(a� $6 Each
( 1 ) Feeders/Circuits @ $2 Each I $2
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
Other (Specify)
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)
Requests for Electrlcal InspecUon (REI) with a fee of $250 or less explre 12 months from the filing date. The corrtractor must have the work completed within
the 12 month �rlod or submk another REI that includes the Ins�ctlon fee for the uncompleted work. Inspection fees do not carry over from one REI to
another.
A servlce charge of $30 will be added for all dishonored checks.
I hereby certify that I inspeded the electrical installation herein on the dates stated: � For�pa� n�U��y�
Rough — In Inspection(s) Date �� �
Final Inspection �� Date I�C'D AUG 2 9 200�
� ""' , a..,, �
i rns macenai can o�
TDD (651) 297�798.
REI 02 (6/07)
as large print, Braille or on a tape. To request,
Voice or