P - 76152'� REQUEST FOR ELECTRICAL INSPECTION � �=�,
2 � � �, � � 7 � � � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edecdricdty.state.mn.us �' "
Describe -using the l�sk of the white copy'rf necessary - the work covered by this requast:
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GENERAL FEES Outdoor Li f�ting Standard @$1
SERVICES / POWER SUPPLIES . . Traffic Signal Stendard (1a $5 .
to 800
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CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Uevice or Apparetus $.50
ADDITIONS TO THE GENERAL FEES
MULI1FAMILY DWELLINGS (PER UNITI
Manufadu�ed Home Park
�THIS INSTALLATION MAY BE ORDERED [
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Fee
ONE & 1W0 FAMILY OWELLINGS, EACH UNff .
Includac the Service and/or Povrer Supply up to 500 Amperes, wi g5 . 50
Cirarits ami Two Inspaction Tdps F�ch DweAing Unft @$80
Additional Ins on Tri $20 ' �
Irn�stiaative Fes _
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total f� is
85.501
latlon desaibed hmein an the dates ste�:
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�� Rough-in Inspedion Required? � Yes ❑ No Inspection OFher Than Rough-In: 0 Ready Now � WN Ca0
8-28—� 6 You must call the inspedor when ready! Date Ready.
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical woiicc at
Job Site Street Address City
5941 3rd Street Fridley
rownsnip section Range Flre No. coumy
Blue Print Homes
eiecm�ai uuucy ae
Xcel Energy
Cantradar/CompanyName
Lazer Electric, Inc.
Maiting Address (CoMredar, Company or Owner PerPorr
8164 Ar�par Street NE. ,
ar
/
CA01110 U�� Number
Iake Park, MLV 55432
Please Provide Two (2) Phone Numbers I
'�63)784-3729 ( �
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