P - 78296REQUEST FOR ELECTRICAL INSPECTION
C C� Minnesota Board of Electricity ��
'�-� 3 5� J��J �a21 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us ✓ i�� �
Identify the work covered by this request: ��( �a � r► 5 t r V! G� R,'s e r--
❑ NEW ❑ REMODEL ❑ADDITION j�iEPAIR
GENERAL FEES Outdoor Li htin Standard �$t
. SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Am re � Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Suppiy up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tri s Each Dwellin UnR �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ion Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Rein ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to t2 Units �$50 Per Unit (minimum total fee is $20
EeCh Additionfll UOit �$25 FOH INSPECTOR USE ONLV
OTHER ADDITIONAL FEES ' �0, S
Li htin Retroffi �$.25 er Fixture
Center Pivot Irri ation Boom �$40
ManUfaCtur2d Home Park Lots �$25 I hereby ce ' Nat I inspected ihe electrical installation described herein on the dates sfated:
Recreational Vehicle Park Sites �$5 R�UGN IN pA,�
Se arate Bondin Ins ion �$20
S ial Ins ection �$30 r Hour 'x'"� "'�"�" oA�
S ial In ' �$.31 r Mile ���� �C�' 1.�—Q3
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY rt
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
1 1/ 3/ 0 3 You must call the inspector when readyl Date Ready:
I certify that I am the ICENSED CONTFIACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, ox, or Rou[e No.) /� City Zip Code
V
6220 Baker Ave. NE
Section Township Range �/ Fire No. Coun
�� °�7 Anoka
Occupant Phone
Judith Blanchard �� �
Power Supplier ; _ � . qd
Elec[rical Contractor / Company
Mr. �Elec� �
Mailing AdtJress (Contra r,
6�451 Mc i 7
�:.1'L�.�h �
E&OOOOtA-13 7/1/2000
(� �Q�� �C.J/(il..Sl�14�
Contractor License Number Master License Number
o CA03589
Perfortning Installation)
NW
� r Perfortning Installation) hone
763-422-9881
BOAHD OF ELECTRICITY COPY IN3TRUCTION3 ON BACK OF YELLOW COPY