P - 79910, REQUEST FOR ELECTRICAL INSPEC710N
Minnesota Board of Electricity
1-390-853 � �821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-B00-627-3529/'
www.electricity.state.mn.us � �
Identify the work covered by this request: Q��
❑ NEW ❑ REMODEL ❑ ADDITION O REPAIR
to 800 Ampere �
ve 800 Ampere �
0 fo 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units �$50 Per Unit
Each Additiona! Unit � $25
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* 1 3908538''
Transtortners up to 10
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
includes the Service andior Power Supply up to 500 Amperes, All
Circuits and Two inspection Trips Each Dwelling Unit �$E
Additional Ins�ection Trios � $20
Fee
FOq INSPECTOq USE ON�Y
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TOTAL FEE
total fee is $201
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I hereby certify that I inspectetl the electncal instellatlon described herein on the detes state�
RWGH IN DATE
FINAL INSPECTION � �ATE
3� �`
�NECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
�*�
�,s �
o Inspection Other Than Rough-in: eady Now ❑ Will Call
� �'-'"'-°" � You must call the inspector when ready! � Date Ready: �
I certi(y that I am the f�IICENSED GONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
7331 MELODY FRIDLEY
Section Township Range Fire No. County
�OK.I�
OcCUpant Phone
PHYLIS DARVINAINEN 763-78d-0441
Power Supplier Addr
N/A *
Electrical Contractor / Company Name Contractor License Number Master License Number
KOYAR ELECTRIC LLC CA03644
Mailing Address (Contractor, Company or Owner Performing Installation)
23049 ARROWHEAD ST NW ST CIS MN 55070
Authorized ' ature (Contractor, Company or ner orming Installation) Phone
763-753-5731
EB-00001A-13 �/1/2000 BOARD OF ELECTRIClN CAPY 1NSTRUCTIONS ON BACK OF YELLOW COPY