P - 76946Minnesota Departm t of Labor and Industry
443 Lafayette Ro North
St. Paul, MN 5 5-4342
Phone: (651) 4-5064
TTY/MRS: ( 1) 297-4198
www.electri y.state.mn.us
Contr ctor Re uest for Electrical Ins
Date Rough-In Inspection Required?
09/12/2007 Contractor Must Schedule All Rou h-In
Address of Inspection - Street
c��� �nincuinir_Tnni eT ni�
Owner Name
DAN LARSON
Owner Telephone Number(s) - Include Area Code(s)
(763) 571-7427
Contractor Name
CENTERPOINT ENERGY
Contractor Telephone
(763) 757-6202
Signature
Yes
o�L���"� i i I �-
RE�D SEP 17 2007
- One Famil Dwellin /Associated Structure
Single Inspection Other Than Rough-In: � Ready Now
Contractor Must Schedule All Final Ins ections ✓Q Will Schedule
City/Township County
FRIDLEY ANOKA '
Project Description
WIRE/ RECONNECT AIR CONDITIONER � .
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
or Associated Structure
Existing Home/Structure Remodel or Addition
-'-,-�.
New Dwelling Service/Power Supply 0-`dOC�aazp,�r,e_@ $35 New Service/Power Supply 0- 400 ampere @$35
New Dwelling Service/Power Supply 401 - 800 ampere @$60 New Service/Power Supply
New Dwelling Feeders/Circuits New/Extended feeders/Cin
- More than 30
Other (
to 30 Feeders/Circuits - $
s/Circuits (in addition to
s U� To 200 A Ccil $6 Each
Detached Garage or Other Associated Structure
New Service/Power Supply 0- 400 ampere @$35
New Feeders/Circuits ( ) @ $6 Each
Other(S
401 - S00 ampere @ $60
:s - Up to 1��e��rs/�ircaits
$6 Each or 16 to 30 @$100
- More Than 30 Feeders/Circui
ts Uo to 200 A CcD $6 Each
Reconnected Feeders/Circuits
( 1 ) Feeders/Circuits @ $2 Each $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 TOtel (the fee calculated above or $35 multiplied v"
by the number of required inspection trips, by the number of required inspection trips, ��5 .
whichever is greater) whichever is greater)
Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The contractor must have the work completed within
the 12 month period or submit another REI that includes the inspection fee for the uncompleted work. Inspection fees do not carry over from one REI to
another.
A service charge of S30 will be added for all dishonored checks.
I hereby certify that I inspected the electrical installation herein on the dates stated: For Department Use Only
Rough - In Inspection(s) Date
nspection
This material can be made
TDD (651) 297-4198.
REI 02 (6/07)
Date
— / d � �7
n different forms, such as large pi
Braille or on a tape. To request, call 7-800-342-5354 (DIAL-DLI) Voice or