P - 76621'] REQUEST FOR ELECTRICAL INSPECTION �
1��� J- 4 4 5 8❑ Minnesota Board of Electricity r
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �. ,
8364-2006 1-783-44 �651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
�escribe -using the back ot the white copy if necessary - the work covered by this request:
new home - twin
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard @$5
0 to 400 Ampere $25 Supplemental Fee @$20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Ampere (a� $75 Transformers over 10 KVA kil $ 20
� Above 200 Ampere @$10 /� �
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALWG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL fEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Addilional Unit @ $25
OTHER ADDITIONAL FEES
Retrofit (�a $.25 per Fixture
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
Fee
Fee
total fee is $20) � $85.50
thal I inspected the electrical instaliation descnbed herein on the dates stated:
Se rate Bondin Ins ection $20 Z, -�JG
Sp2Ci21 InSpeCtion @$30 pBf HOU� exPiaeo aenNOONeo onre
S cial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Robert Clauson
(651) 777-7885 INSPECTED LOCALLY �
' Date: j Rou h-in Ins ection Re uired? �'�
9/14/2006 9 P 4 �es ❑ No j Inspection Other Than Rough-In: ❑ Ready Now �/ill Call
I�! You must call the inspector when ready! Date Ready: i
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I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Job Si[e Street Address City
1484 - 73 1/2 Ave NE _ �Fridley �
� Township - '� Section Range . Fire No. �� Count
Y
'�Anoka
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���Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
Sterling Homes ((76�)434-5114 ( )
ElectricalUtil�itv - - -��ElecVicalUtilityAddress �
XCeI tf12C'gy , 3115 Centre Pointe Drive, Roseville, MN 55113 -(800)628-2121
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i Contractor / Company Name - Contractor License Number ! Master Electrician or Power Limited Technician
Aircon Electric Corporation CA00141 License Number
� 2�43 -'�35th Lane f�w -- Andover, MN 55
Mailin Address Contractor, Compan or Owner Performmg Installation) �
304
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Authorized Si ure ( ntractor or O r Pe rming Inst Ilation) � - ��- � Please Provide Two (2) Phone Numbers Including Area Code
�(�763) 757-2120� �
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