P - 79134REQUEST FOR ELECTRICAL INSPECTION
1����1„� � 5 7 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
�I NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy iF necessary - the work covered by this request:
GENERAL
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 8.50
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Porrer Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellirg Unit @ S80
Fee
fIFAMILY DWELLINGS PER UNI TOTAL FEE 46. SO
3 to 12 Units @ S5o P� unit (minimum total fee is $20)
EeCh Addi60nal Unit �$25 T�xs ue�, Foa warECTa usE aar
I hereby cerOfy tl�ad I inspecBeO Uie Hectrical i�q6adon tlaaibed hc¢in on tlie da�s ataBed:
OTHER ADDITIONAL FEES 1�u L� � Cy a� r�
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You must call the ins �+gh-In: OReady Npw yy� �g
P�tor when readyl Date Ready.
� certify that 1 am tlie �LICENSED CONTRACTOR ❑CONPANY � OWNER and hereby request ir�specao� of 1he electrical work at:
J� �is ianse�n"iane
_ Fridley � �
Cbrp.
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,U1110 - -_._- � «
Lioanse Number
Park. N1IV 55432
�Am � , �i'-�� r�-�y�� I /63-784-3729
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- �800007A-14 8.1. T004