P - 818121-375-811
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Robert C;lauson
(6511777-7885
IdentiTy the work covered by this reques
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REQUEST FOR ELECTRICAL INSPECTION
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�Minnesota Board of Electricity � � .
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 .� :'
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.u�NSPECTED LOCALLY
t:
N Il0 REPAIR ������" � �'�' � `�' � �
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
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 Additional Unit � $25
Transformers over 10 KVA � $20
Tiansfortners / Power Supply for Signs / Outline Lighting �$�
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspedion Trips Each Dwelling Unit �$80
Additional Inspection Trios � $20
FOP INSPECTOR USE ONLY
TOTAL FEE
�I fee is $20}
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$2 1 hereby certity [hat I inspected the eleqrical insteilaUOn described �erein on tlie dates stetetl:
Recrea6onal Vehicle Park Sites � ti/► ROUGH IN DATE
S arate Bornii In ' n�$2
S ial Ins 'on �$30 er HOUr FIIUL INSPECTION oa�
S ecial Ins ection �$.31 per Mile -— CJ
THIS INSTALLATION MAY BE ORDERED DI,�SCONNECTED __ OT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE O
I II�III IIIII IIII) I�III IIIII II�II �� ��� ��)
" 1 3 7 5 8 1 1 5*
Request Date: Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-in: ❑ Ready Now �Wfll Call
You must call the inspector when ready! Date Ready:
I certify that I am the f�iCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at:
i Job Address (Street, Box, or Route No.) City Zip Code
� Section � Township
Edson, Maynard —
Power Supplie�
Excel Energy {NSP)
Electrical Contrador / Company Name
Aircon Elect�ic Corporai
Mailing Address (Contractor, Company or
?�d� '1 ��th 1 3na Nw __
f B-00001
Range � Fire No.
Phone
Address
3115 Centrre Porc�te Drive, RoseviMe, MN 55113 -(651 j826-2000
Contractor License Number Master License Number
GA�141
forming Installation)
ni Ins ' ) I Phone
{763) 757-2120
BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY