P - 79108REQUEST FOR ELECTRICAL INSPECTtON
� r� 3 q. �' ��� � Minnesota Board of Electricily -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTl'/MRS 1-800-627-3529 www.electricity.state.mn.us
O NEW ❑ REMODEL 0 ADDITION ❑ REPAIR Describe -using ihe back of the white copy if necessxy - the work covered by this request:
Boiler
GENERAL FEES Outdoor Li h6n Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Shandard E5
0 to 400 Am e$25 Su lemental Fee $20
401 to B00 Ampere �$50 Transfonners uo to 10 KVA na. $10
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Addition� Unit �
Mile
�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIfIN�I�
16348054
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Ir�cludes ihe Service andla Power Supply up to 500 Amperes, All
Grcuits and Two inspection Trips Each Dwelling Unit �$60
TOTALFEE
(minimum totai fee is S20) 20 . 50
TMLSARFA FOR pbP[CTpi USE pILY
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Request Date: R�9h'm �gP� �eQ���zd? Yes No
U�speaion O�r �man Rapn-►n: nReedy wow O wsu ca�l
7/14/04 Y«�m����a�� n��a,,: 7/16/07 After noon
I cerMy that I am tlie f$LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection � the electripl work at:
Job nadress (see�. eox or � Nu.i C1ry Zp code
7310 Concerto Curve Fr_ir�1PV ��e��
Biomara Hanson
(76� 717-0216( )
Robbinsdale Electric Company I CAp1549
� Address (co�rtracDo►, campeny or owner „g Yist�al{,,,)
�4 Weat Broadway Robbinsdale N�T 55422
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763-588-'�004
. . EB-00001M11 &1.2002