P - 80045REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
r 1-396-107 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity,stafe.mn.us ' �
Identiiy the work covered by this request:
❑"NEW ❑ REMODEL ❑ ADDiTION ❑ REPAIR
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCU�TS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO TH� GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Home Park
� $30 oer Hour
XCEL ENER�Y SAVER'S SWITGH
Transformers over 10 KVA � $20
Transfortners / Power Supply for Signs / Outline Lighting �$;
ONE 8 TWO FAMILY DWELIINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$80
Additional Inspection Trips � $20
FOF INSPECTOR USE QVLV
I hereby certify Mat I inspectetl the elecincal installation described herein on ihe dates stetetl:
ROUGHIN DA7E
FIN4L INSPECTION / DATE
C� 25 = 03
� FOR OFFlCE USE ONLY
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Reque��}�fQ'2 Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-in: Ready Now ❑ Will Call
You must caU the inspector when ready! Date Ready:
I certify that I am the I� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (St �cit' Bo�ccAaW.NaIE C�� FRIDLEY ZiP �ode �j�{32
Lg/ / I 1"1 f'L 1`7
Section Township Ran e Fire No. County /�j�J�,'�(/�
.
°c�OR��fERSON RICHARD DARRYL � Pnone
Power Su ier � Address
Elactrica� �optr�,1 �,c�Qap��jl�a,,,,,,,,,�,rrQN Contrector Lice,��e �y�pq@� Master License Number
i�•�uiv LC�. i f{ �: WKf��� t.r� wttt�
Mailin9 �[�l � 1 C7FilALYhiU/W r� PS�f Fi��1�`�,�i1N 55114
Authorize ' nature (C9plractor, ompany or Owner Perfortning Installation) Phone �1 846-2Q11
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EB-OOOOtA-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY