P - 76723Minnesota De rtment of Labor and Industry
443 Lafayette oad North
St. Paul, MN 155-4342
Phone: (651 84-5064
TTY/MRS: (6 ) 297-4198
www. electricity.stai�. m n. us
Contractor Re uest for Electrical In
Date Rough-In Inspection Required?
01/17/08 Contractor Must Schedule All Rou h-I
Address of Inspection - Street
6134 WOODY LANE
Owner Name
PUBLIC HEALTH SOLUTIONS
Owner Telephone Number(s) -'Include Area Code(s)
(612) 245-2511
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��'p J AN 2 2 2008
�tion — One Famil Dwellin /Associated Structure
y� Single Inspection Other Than Rough-In: Ready Now
:ctions Contractor Must Schedule All Final Ins ections ✓❑ Will Schedule
City/Township County
FRIDLEY ANOKA
INSTALL UNIT HEATER IN GARAGE
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4'-(if -'— / e .-� � ,c,. �
Contractor Name Contractor Mailing Address
ERICKSON PHC 1471 92ND LANE NE BLAINE, MN 55449
Contractor Telephone Number Contractor E-mail Address Electrical Utility
Contractor License
CA02266
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
New Dwelling Feeders/Circuits
30
New Home -
Feeders/Circuits Uo To 200 A
Other (Specify)
w-�➢
i to
Each
Detached Garage or Other Associated Structure
New Service/Power Supply
New Feeders/Circuits
Wire unit he
Other (Specify)
0 - 400 ampere @ $35
( ) @ $6 Each
TOt81 (the fee calculated above or $35 multiplied
by the number of required, inspection trips,
whichever is greater)
Job/Project Contact Person
DAVE M
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 [D_ $6 Each or 16 to 30 cCD. $100
New/Extended Feeders/Circuits - More Than 30 Feeders/Circui
( ) Feeders/Circuits Up to 200 A(a� $6 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
Other (Specify)
�S� � I Total (the fee calculated above or $35 multiplied
by the number of required inspection trips,
� whichever is greater)
Requests for Electrical Inspection (REI) with a fee of 5250 or less expire 12 months from the filing date. The contractor must have the work completed within
the 12 month period or aubmit 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. -�� �
_ �
Rough – In Inspection(s)
on the dates stated:
Date
Finallnspectio � Date
���C
This material can be made available in different forms, such as large pi
TDD (651) 297-4198.
REI 02 (6/07)
or on a tape. To request, call
or