P - 75911r� REQUEST FOR ELECTRICAL INSPECTION
L.� � o� c� 6 q, o� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectriciry.state.mn.us
Describe -using the bac e whit copy if ne�.sary - the wrork covered by this requ�t:
Wire Air C,�nditioner
GEirtRAL FEES Outdoor LighUng Standard @$1
� CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
Ea�h
over 10
Includes the Service and/or Power Supply up to 500 Amper�, All
Circuits and Two Insp�Uon Trips Each Dwening Unit @$80
Additional Ins 'on Tri $20
Investlgative Fee
Reins 'on Fee $20
TOTALFEE
(minimum total fee is $20) $35. 50
7HI3 AREA FOR N'SPECIOR USE OMLY
I herebvi ceAHv thet I inspeded the electrlcal Uistallatlon described frerein an the dates �ted:
�� eTION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 N
FOR r,rE C'`c Uu[ C�"� Y
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��� Rough-in Inspectlon RequiredT �Yes ❑ No Inspedion Other Than Rough-In: � Ready Now ❑Wiil Call
6-7-06 You must call the inspector when readyl Date Ready.
I cefify that I am the $XLICENSED CONTRACTOR ❑ COMPANY � OWNE12 and hereby request inspe�tion of the etectrical work at
Job Site Street Address ��
6531 McKinley Strcet NE Fridley
-r!�!_��
Electric, Inc.
Please Provida Two (2) Phone Numbers including Area
� � � /
ise Number Mas[er Eledridan or Pm�rer Limited l
Ucense Number
10
Please Provide Two (2) Phorre Numbers Including Area
�(63) 784-3729 ( )
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