P - 75705y REQUEST FOR ELECTRICAL INSPECTION �
2� 1��� 2 6 4� Minnesota Board of Electricity ��'��
�—' 1821 University Avenue Suite 5-128, Saint Paul, Minne.sota 55104
.
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.�ntzus �" `
Describe -using the bac,k of�the whde copy ff necessary - the work covered by this requ�t:
IMMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Aaaaratus aC2 $.50
.TIFAMIL
3 to 12 l
Boom
ecial Inspectlon @ $.31 per MOe
INSTALLATION MAY I
IWIUU�uu��luII�IIIItIIIulllll�uu� I�
�1552641
Outd�r
Fee
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two InspecUon Trips Each Dwelling Unit @$80
.
Additional Irrc 'on Tri $20
Investi ative Fee
Reins 'on Fee $20
TOTALFEE
(minimum total fee is $20)
rws aaea Foa wsa�cr� us� aar
o�- V� � e�
I hereby ceAify thet I hispected Nre eledrical ir�tellatlon desaibed hereln on the dates at�ed:
Rax,�m a onre
`� �-.tE- �
� ��
� ��� -� �-z� ��
D IF NOT COMPLETED WITHIN 12 MONTHS
��.�OF:O�F�CE USF rjtJ� � T�'-'c__� �( -
RCI. U .� � �{ � 20�% � � �
�
� ��`� -01 �l�`�
O� I 8—U / Rough-In I�pecdon Required7 �]Yes ❑No Inspectlon OtherThan Rough-In: ❑ Ready Now�1WIlI Call
You must cali the hispedor when readyl Date Ready:
I cer6(y that I am the �[1 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requsst i�s�Ction of the electrical work at
�`' �9�` `�d3�rd Str�t �`�
Fridley
ue Print Hoanes
�
� �
wnu�or ucensa rvumoer mascer tiecmaan or rower L�mrcea rechroclen
CA01110 u`�"� "w"`�'
ry or Owner Pertormh�g Installatian)
. NE, spri.ng Lake Park, M1V 55432
,�rfOrming Instal�atlon) Please Provide Two (2) Phorre Numbers Including Area Code
� (76� 784-3729 ( )
:OPY BpARD OF ELECTRICITV COPY FF_M11M9 D�c c��rmn