P - 75888REQUEST FOR ELECTRICAL INSPECTION ��'
1� 9 9�°� 2� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
#]Q�L�. (651) 642-0800 TTY/MRS 1-800-627-3529 www.electr%city.stade.mn.us
Describe -using �e ck of the white copy d necessary - the work covered by this request:
Re�tove abandoned wiring in garage. Rework improper romex installat i
GENERAL FEES Outdoor Lighting Standard @$1 lII a s ement .
SERVICES / POWER SUPPLIES Traffic Siqnal Standard na. $5
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS
Each Svstem Device or AonaraUrs an $.50
Each Additional Unit @ $25
OTHER ADDRI01
Liahtina Retrafit C� $25 aer Fbcture
Speaal Insp�tion @ $30 r Hour
Special Ir�spection @ $.31 per Mue
THIS INSTALLATtON MAY BE ORDERE�
I Ilu II uI I�I�I II ul (�II� II �I II III � I� �� I�
1992327'�
Includes the Service and/or Power Supply up to 500
Circu(ts and Two Inspe�.fion Tdps Each Dwell
Addi�onal Ir�s�ction Trips C� $20
total fee is
All
$80
I herebY certffv that I inspeded tlm electrlcel I�tallatlon desaibed herein on the datea steted: I
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��� Rough-fi Insp�tlon Required7 ❑ Yes �No Imspection Other Than Rough-In: � Ready Now ❑NM Call
S/ 2 4/ 06 You must call the inspector when readyl Date Ready.
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec�on of the electrical work at
Job S(te Street Address City
402Q Main St. NE Fridley
Townehfp Sectlon Range Fire No. Courriy
Anoka
Owner/OccuoaM Name Please Provide Two (21 Phorre Numbers Ineludina Area Cade
Evelyn Cornelius
Electrical Utllity E
Xcel Ener
Contrador / Company Name
Heights Electric, Inc.
Mailing Addrass (Contractor,
704-40th Av NE Col. H
I CA000827
aaffiNetlen)
., MN 55421
788-6770
M89[8f EIBCtriCIHIi O�
License Number
( 76� 788-8888 (