P - 76411REQUEST FOR ELECTRICAL INSPECTION '�
" Minnesota Board of Electricit �-�
2-05��106 0 Y k �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
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"GENERAL FEES nufdnnr I inhfinn S}andarri �l G1
/ICES / I
0 to 400
Above 200 Am ere �$10 'T
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL F
3 to 12 Units @ $50
Each Additional Unit
OTHER ADDITIONAL FEES
fit @ $.25 per Fixture
ngation Boom @ $40
Home Park Lots (� $25
s ecial Inspection $30 per Hour
S ecial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED
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�05A1062
Standard
Fee C� $
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All $�j .�j
Circuits and Two Inspection Trips Each Dweiling Unit @$80
Additional Insceclion Trios (� S20
total fee is
85.50 I
I hereby certify that I inspeded the elecVical installaGon described herein on Me dales stated:
RoucN w / DATE
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FINp1INSPECTION //� �j f pq�
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NECTED IF NOT
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WITHIN 12
""" Rough-in Inspection Required? $�Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now 1plWill Call
�� 9—ZS—OG You must call the ins ector when read !
P y Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address C�y
5921 3rd Street Fridley
ier/Occupant Name - Please Provide Two (2) Phone Numbers Including Area
Blue Print Homes � � � �
Nical Udlity Electrical Utility Address
Xcel Energy
tractor / Company Name Contrador License Number Master Electrician or Power Limi[ed T
Lazer Electric, Inc. CA01110 License Number
ing Add (Contractor, Company or Owner Perfortning Installation)
81�Arthur Street NE., Spring Lake Park, MN 55432
Area
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OF COPY BOARD OF ELECTRICITV COPv