P - 766201 7 8 3 4 4 6 6 REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity �e ,;
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �: ;
(651) 642-0800 TTY/MRS 1-800-627-3529 wtir�+�.electricih•.state.mn.us
DesCribe -using the back of the white copy if necessary - the work covered by this request:
new home �twin
0 to 400 Ampere @ $25
401 to 800 Ampere @ $
Above 800 Amoere n $
)MMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
>ystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
3to1
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $4(
Manufactured Home Park Lots (cil $
Outdoor Lighting Standard @ $1
Tra�c Signal Standard @ $5
Supplemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer 1 Power Su I for Si ns I Outline Li htin $5
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
TOTALFEE
total fee is $20)
that I inspected the electrical installation descnbed herein on ihe dates stated: �
� �3� �
Special Ins ction $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17834466 '�"��
Robert Clauson
(651) 777-7885 INSPECTED LOCALLY � .
I Date: Rough-in Inspection Required? es ❑ No � Inspection Other Than Rough-In: ❑ Ready Now�Will Call
9/14/2006
i You must call the rnspector when ready! _ Date Ready:
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
1486 - 73 1/2 Ave NE ��Fridley
Sterling Homes
Aircon Electric Corporation
i�Meilin Address (Contrector, Compan or Owner
! 2�343 - 135th Lane I�w -- Ai
,
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Authorized Sign34ke{6�pntractor or OwnpyPgr
� �,r,.�-w,..�.
INSTRUCTIONS ON BACK OF YELLOW
Range � Fire No.
Niease h'rovitle ��wo (2) Phone Numbers Including Area
�(76�)434-5114 ( �
�, Electrical Utility Address
' 3115 Centre Pointe Drive, Roseville, MN 55113 -(800)628-2721
L i Contractor License Number Master Electrician or Power Limited l
CA00141 License Number
r, MN
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dlation) - Please Provide Two 2) Phone Numbers Including Area Code
-- � (�763) 75�/-2120� �
BOARD OF FLECTRICITV COPV Fa_nnnn�n_�s a� onnn