P - 81945. . . . TREQUEST FOR ELECTRICAL INSPECTION
1� 1�Z 3� 7 O 4. *��. 8121 Un�ver � A enue Su ter'S 28, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '� ''
IdentiTytheworkcoveredbythisrequest: FAMILY ROOM ADDITION: bathroom
❑ NEW C�REMODEL �] ADDITION ❑ REPAIR �TSTA�.1L 2 BASEBOARD HF,ATERS
GENERAL FEES Outdoor Li hti Standard �$1
SERVICES / POWER SUPPLIES TraSfic Si nal Standard C� $5
0 to 400 Am ere �$25 Su lementaf Fee �$20
401 to 8(l� Am re �$�0 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS ! FEEDERS Transfortner / Power Su I(or Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, Alf
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuds a�d Two In ion Trips Each Dwellin Unit f� $80
CIRCUITS, CIRCUITS OF LESS 7HAN 50 VOLTS Additional In an T' s�$20
Each S stem Device or atus �$.50 Irnesti ative Fee
ADDlTIONS TO THE GENERAL FEES Reinsnection Fee �$20
total fee is
�ditional Unit � $
OTHER
Retrofit � 5.25 i
I herebvi cerdM that I insoected the electrical instaqation described herein on
Vehicle Park Sites �
TFfIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEO
FOR OFFlCE USE ONLY
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� 6- 2 0- 01 I You must call the inspeclrn when readyi I Date Ready: I
i certify that I am the [�UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (SVeet, Box, or Route No.) City Zp Code
895 76TH AVE FRIDLEY
Section Township Range Fre No. CouMy
OccupaM Phone
Power Supplier � ^ � Address
�
Electricaf Contractor / Company Name CoMractor License Number Master License Number
WEST CA01936
Mailing Address (Contrador, Company or Owner Performing Installation)
6324 LAKEL D N BROOKLYN PARK M1V 55428
A ' ed.6ignature (C r, Company or Owner Pertortning Installa6on) Phone
763-537-0807
E&0000 •13 7l12000 BOARD OF ELECTRICITY COPY WSTRUCTONB ON BACK OF YELLOW COPY