P - 76648�
G ��' `� �' � �� i n ni - 9 2008
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Minnesota Depa ent of Labor and Industry �� 1 �!�/�� _,.y-.��-
443 Lafayette R d North � V�J ��_ �
St. Paul, MN 5 55-4342 ��� (� � I I
Phone: (651) 4-5064 � IIIIIIIIIII
TTY/MRS: (6 ) 297-4198 j� ,� IIIIIIIIII
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www.electrici .state.mn.us + � � � � � � L � „�/��'� � � �;��
Contractor/Re istered Em lo er Re aest for Electricaiins -ec��n- -
Date Rough-In Inspection Required? Yes Single Inspection Other Than Rough-In: � Ready Now
12��3/�7 Contractor/Em lover Must Schedule All Rouah-In Insoectinnc �nntrartnr/Fmnlnvcr Mi icT Crhori� �lo All F' I I t' ✓❑ Will S h d I
Address of Inspection — Street
1501 WINDMERE DR.
Owner Name
ROGER BONA
Owner Telephone Number(s) — Include Area Code(s)
(763) 572-1023
!�4TEC ELECTRIC. lNG.
vonuactori�mpioyer i elephone Number
(763) 537-1570
Signature
Service/Power Supply
If18 nSp@C IOnS C@ U@
City/Township County
FRIDLEY ANOKA
Pro�ect Description
i� s,-►� �� �� r w(;� N� �u� ron- � zvc A q rs
�ontractoriKegistered Employer Mailing Address
3707 SQTH RVE. N. R�!lNNEAPOLIS, MN 5542q
Contractor/Employer E-mail Address Electrical Utility
paul@mtecelectric.com �( �L
Contractor License Number Jab/Project Gontact Perser.
CA03864 IPAULARCHAMBAULT (��2_2qp-��9lS
Fee Calculation � � �
ampere @ $35 �n Technology System Devices (
Service/Power Supply 401 — 800 ampere @$60
Service/Power Supply Above 800 ampere @$100
New/Extended Feeders/Circuits Up To 200 A( Z)@$6 Each � Z
for
Equipotential Planes (
Center Pivot Irrigation Booms (
Plus ( ) Electrical
Luminaire Retrofit Modifications (
) @ 75¢ Each
�g Pools and
) @ $35 Each
) @ $35 Each
iits @ $5 Each
) @ 25¢ Each
Feeders/Circuits Above 200 A ( )@$15 Each Concrete-Encased Electrode Inspection ( )@$35 Each
Reconnected Feeders/Circuits Investigative Fee $70 Or The Total Inspection Fee,
( ) @ $2 Each
- Whichever Is Greater U To $1,000
Manufactured Home Park Lot Su I �peciaf Irispection Fee ( j F;ours a� $30 Per Hcur
PP Y ( ) @ $35 Each
Plus Miles The IRS Milea e Rate of
Recreational Vehicle Site Supply Equipment Other
( Circuits Ori inatin in the E ui ment $6 Each State Fee $1
Stfe@t, P2�kitlg LOt, Lighting Standard ( )@$5 EBCh OV@f F)OO VOItS — Add the combined service/power supply and feeder/circuit fee to
result in double the regular fee (does not apply to electric sign and outline lighting)
Transformers Up to 10 kva � ) tvew Muiti-Family Dwellings @$70 Each
( ) @ $15 Each
With Up To 20 Feeders/Circuits
Transformers Over 10 kva ( )@$30 Each ( ) Additional Circuits Above The 20 Allowed Per Unit
6 Each
Electric Signs and Outline Lighting Total (the fee calculated above or $35 multiplied
Transformers/Power Su lies $5 Each by the number of required inspection trips, �
whichever is greater) �' �� . ��3
Requests for Electrical Inspection (REI) with a fee of 5250 or less expire 12 months from the filing date. The contractor/employer 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 char e of 530 will be added for all dishonored checks.
I hereby certify thai I inspected the electrica! installaticn hereEo on the dates stated: For Department Use Only
Rough — In Inspection(s) Date �
Fina
�"/�l�'�—% --c'C�-�–tla ��''�% �
Tnis eiam � can be mad availa le in different forms, such as lar print, Braille or on a tape. To
TDD (651) 297-4198.
REI 03 (6/07)
Voice or