P - 76185REQUEST FOR ELECTRICAL INSPECTION
�� o� o� 9 3��� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
D�scn'be -using the back of the white �py'rf nec�ssary - the work cover� by this req
Replace twa'furnaces and one A/C
- GENERAL FEES Outdoor Uahtina Standard Cc� $1
Above 800
IMMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 UnRs C�a $50 Per
FbcGue
� Transformer I Power Suppiy for Signs / OuUine Lightlng @$5
ONE 6 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, AII
Circuits and Two Ir�spection Trips Each Dwellir�g Unit @$80
total fee is
I Irerebvi certlfv thet I insaeded the electricel instaliatlon desamed herein on the detes sta�: �
Speaal I 'on $.39 r M�7e
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF PIOT COMPLETED WITHIN
FQR OFFICE I�SE �JNL �
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��� Rough-In Inapectlon Requkad7 ❑ Yes �Plo Ins�Ctlon OMier Than Rough-In: � Ready Now ❑ WIA Cell
1 1-1 7- 0 6 you must catl the inspector when readyl Date ReadY•
I certiify that I am the �] LICENSED COMRACTOR ❑ COMPANY ❑ OWNER arni hereby request inspection of the el�trical work at
Job Si6s Sheet Address CKY
5380 6th St. NE Fridlev
IPat Siedlecki
Robbinsdale Electric Co.
Ma�ing Address (Contrador, Company or Owner Perfortning Ins�at
3754 W. Broadway Robbins
AutlieDized Sia�ture (CoMrador or Owner Performing Inatallatlon)
��63�-572-8075� )
trador License Number Master Electric(an or P
Lloettse Number
CA01 5 4 9
-588-700� �