P - 77174REQUEST FOR ELECTRICAL INSPECTION ��
1 �39 1�2 � �:� �
� � ❑ Minnesota Board of Electricity �- �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
�6906 � (651)642-0800TTYlMRS 1-800-627-3529 www.electriciry.state.mn.us . ?;��
Describe -using the back of the white copy if necessary - the work covered by this request:
Remodel urifini.shed lower level.
GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Sianal Standard fa� $5
401 to 800 Am ere $50
Above 800 Am ere a$75
CIRCUITS I FEEDERS
0 to 200 Am ere $�
Above 200 Amcere C�a $10
IALARM, COMMUNICATION, REMOTE CANTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofit C�D $.25 cer Fixture
spection @ $30 per Hour
spection @ $.31 per Mile
ALLATION MAY BE
IIIII IIIII II I�I II I I Illol II III IIIII II III �� I�
1839192p
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit @$80
Additional Ins ection Tri s $20
Investi ative Fee u I' C 3 r 2 (
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) $ 42 . 50
THIS AREA FOR INSPECTIX2 USE ONLV
I hereby cerfiry lhat I inspeded the electrical installation described herein on the dates stated:
:IX���UIy
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WITHIN 12
Date: Rou h-in Ins ection Re uired?
g p q � Yes ❑ No Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
�. 1� n 1� �� You must call the inspector when ready! oate Ready: 11 % O l� 0 S
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address City
660 Central Ave NE Fridle
Township SecGon Range Fire No. Counry
Anoka
OwnedOccupant Name Please Provide Two (2) Phone Numbers Including Area Code
James Travers (6S1� 631-3748 (612� 296-5260
Electrical Ufility Elechical Utility Address
Xcel Energy �Ipls
Contractor / Company Name Contrador License Number Master Electrician or Power Limited Technician
License Number
Heights Electric, Inc. CA000827
Mailing Address (Contractor, Company or Owner Performing Installation)
704-40th Ave NE Col. Hgts., t•;Pd 5�421
Authorized Signature (Con ador or r Pe ing Installation) Please Provide Two (2) Phone Numbers InGuding Area Cade
( 6�763 7F38-8?3�38 ( �
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