P - 77596REQUEST FOR ELECTRICAL INSPECTION ��
1�����- 513 3❑ Minnesota Board of Electricity ;r
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
-513 (651) 642-0800 TTYlMRS 1-800-627-3529 www.electricaly.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this requesT.
SOG 4-Plex
✓ICES / POWER SUPPLIES
0 to 400 Ampere @ $25 /T,. �
401 to 800 Amoere na $50
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus (�a $.50
3 to 12 Units @$50 Pe
Each Additional Unit @
Lighting Retrofit @ $.25 per Fixture
Center Pivot Imqation Boom (�o $4C
Outdoor Lighting Standard @ $1
Traffic Siqnal Standard an $5
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs / Outline Lighting @$5
ONE & 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
Investiaative Fee
TOTAL FEE $85.50
total fee is $201
that I inspected the elecincal installation described herein on the dates stated:
,,-.-.. � onre
� __ � ...�::�?.e�.�.;----� /'i - �. - .2�'-�;
S ecial Inspection @$30 per Hour t%Y1Nt0 "'"N°0Nt0 — — — o"'
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I I�I II li� II �1 II IIi II III II ilI II i� i� III II III i IIII
1 7 7 5 5 1 3 3
Robert Clauson
INSPECTED LOCALLY
� ���-/
�
�,��q
a
."""� '�� Rough-in Inspection Required? B Yes LJ No ', Inspection Other Than Rough-In: LJ Ready Nov�IWill Call
'' 2�� 0�2�0`5___ II vou must call the inspector when ready! �Date Read
---- � _. ..._ _ y' _
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
— - — __ — — - _ _ __ . _-- --
i Job Site Street Address - City
I ��d� �th Straat NF Fridley
' Township I� Section 'I Range I Fire No. j County
'�, I Anoka
_ _ __-- - — _ __ ___— _
OwnedOccupant Name 4 Please Provide Two (2) Phone Numbers Including Area Code
I Tradition Homes __ ___ �((763)712-1021 ( )
' Electrical Utility � � �� �lectrical Utiliry Address
NSP1 _� 3115 Centre Pointe Drive, Roseville, MN 55113 -(800�28-2121
�� Co�/ ompan a�e " � '�, Contractor License Number ' Master Electrician or Power Limited Technici
I License Number
'___Aircon Electri_c Corporation CA00141 �
_ --- - —
I Mailing Address (Contractor, Company or Owner Performing Installation)
Please Provide Two (2) Phone Numbers Including Area Code
�76 757-2120 � )
ca_nnnn�n_�s n �