P - 79916�
_ _
' REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1-396-144 � 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn. us
Identify the work covered by this request:
O I�EW ❑ REMODEL ❑ ADDITION ❑ REPAIR
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWEILINGS PER UNI�
3 to 12 Units � S50 Per Unit
lJ
XCEL EIVEROY SAVER'S SWITCH
iransrortners over iu KvA a��u
Transfortners / Power Supply for Signs / Outline Lighting �$!
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circu'ds and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
�
FOF INSPECTOfl USE ONLY
TOTAL FEE
I hereby cenity that I inspectetl the elecirical instelletlon described herein on tlie tlates stated:
ROUGHIN DATE
FINAL INSPECTION � �� _ DATE
FOR OFFICE USE ONLY `
IIIIIIIIIIII�IIIIIIIIIIIII�IIIII�I��I�
* 1 3961 446* ��� o���.
Reque��JQ� F±ough-in Inspection Required? ❑Yes Ij�NO Inspection Other Than Rough-in: I�Ready Now ❑ WII Call
You must call the inspector when ready! Date Ready:
I certify that I am the C� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (S1r��' Bo .x p,BpySe,yp1,E � C� FRIDLEY �p �8 ��
Ol 1"I�JG3V b I lY
Section Township Range Fire No. Counry AtVOKA
`
°ixop�!°fT0 RICHARD E : PFwne
Power Su lier E�� Address
Electric��������T�QN Contrector LicgQ�e by�� Master License Number
4rA �)UHtl
Mailin9 Addresg 1Goot[acto[.�anpanv�r�rne � P���,��uo�N 55114
I,�W 1 tt�il l C]F�IRL FiUML1
Authorize ature (�ractor mparry or Owner Perfortning Installation) Phone �
�� �.,� a�a-zu�i
E&00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON �BACK OF YELLOW COPY