P - 77597REQUEST FOR ELECTRICAL INSPECTION
1� 7� 5`� � 1 2 � Minnesota Board of Electricity �-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � 1
7744-2005 1-775-512 � 6 5 1) 6 4 2- 0 8 0 0 T T Y/ M R S 1- 8 0 0- 6 2 7- 3 5 2 9 www.e lectriciry.stute.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
SOG 4-Plex
! POWER SUPPLIES
� 0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retroft an $.25 per Fixture
Manufactured Home Park Lots I
Recreational Vehicle Park Sites
$30 per Hour
Tra�c Signal Standard
Supolemental Fee C� $
over
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiqative Fee
iv�r��roo $g5.50
(minimum total fee is $20)
the electrical installation descnbed herein on the dates stated:
�1�I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I ilil II UI il lii II �I il III II ul II III II Ili II ill I IIII
Robert C auson 5 1 2 S
(651)777-7885
INSPECTED LOCALLY
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. Date: I Rou h-in Ins ection Re uired. es
2/10/2005 ' 9 P 4 �� � No ! Inspection Other Than Rough-In: ❑ Ready Now � ill Call
_ l.You must call the inspector when ready! � Date Ready:
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I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
�ob Site Street Address City
5541 5th Street NE Fridley
Township —�Section Range I Fire No. County
rOwnedOccupant Name - � , � � � � L � � i�Please Provide�TL An�ka
wo (2) Phone Numbers Including Area Code
Tradition Homes !(763�712-1021 ( )
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Electrical Utility - '� Electrical Utility Address
XC21 E11@('gy (NSP) _, 3115 Centre Pointe Drive, Roseville, MN 55113 -(800�28-2121
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rContrector / Company Name '�. Contractor License Number Master Electrician or Power Limited Technici
Aircon Electric Cor oration CA00141 '`10e"Se "�"'be`
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I Mailing Address (Contrector, Company or Owner Performing Installation) ��� -� �
2343 -135th Lane Nw — Andover, MN 55304
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Aythorized Signature (C � r c� or Ow�orming Installation)
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Provide Two (2) Phone Numbers
� 757-2120 � �