P - 76438REQUEST FOR ELECTRICAL INSPECTION '�
..�. ��9 2 7�� o� � Minnesota Board of Electricity S4962V �'
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ��
(651) 642-0800 TTY/MRS 1-800-627-3529 www.e 'ci tate.mn.us
Describe -using the back of the white copy'rf necessary - the work covered by this request:
WIRE FURNACE WIRE AIR CONDITIONING
GENERAL FEES Outdoor Li hting Standard $1
SERVICES I POWER SUPPLIES Traffic Signal Standard frD $5
0 to 400 Ai
401 to 800
Above 800
)MMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus (�D $.50
MULTIFAMILY DV
3 to 12 Units
Lighting Retrofit @ $.25 per Fi�Aure
Center Pivot Irrigation Boom @ $40
Manufactured Home Park Lots @ $
Recreational Vehicle Park Sites (� I
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investi ative Fee
Reins ion Fee $20
TOTALFEE
(minimum total fee is $20)
THIS PAEA FOR INSPECTOR USE ONLY
I hereby certify ihal I inspected the electrical installation described herein on the dates stafed:
�— �� � G � I
5 ial Inspection $.31 per Mile
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED_IF NOT COMPLETED WITHIN 12 MONTHS
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],9273028
uaie: Rough-in Inspection Required? ❑Yes
12/15/05 No Inspecfion Other Than Rough-In: ❑ Ready Now �Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address C�y
CHODON, 1291 HILLWIND RD FRIDLEY
T�wnshi -. _—.--
I P I Section I Ranae Fire No. Countv
� CHODON, 1291 HILLWIND RD
INC
Please Pro�ntle Two (2) Phone Numbers
� ) � )
Master Electrician or
License Number
Mailing Address (Contractor, Company or Owner Perfortning Installation)
14800 28TH AVE N, SUITE 125, PLYMOUTH, MN 55447
Authoriz� Sig� tu�re (Con�actor or Owner Pe orming Installation) Please Provide Two (2) Phone Numbers Including Area
��.'X-Ci � �-� (763)498-7215 ( )
INSTRUCTIONS ON BACK OF YELLOW COP BOARD OF ELECTRICITV COPV rasmm e_.c