P - 78665REQUEST FOR ELECTRICAL INSPECTION � �
1� 41. 2— 7 9 4� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
F (651) 642-0800 TTY/MRS 1-800-627-3529 www•electricity.state.mn.us
�JEW ❑ REMODEL O ADDITION 0 REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
PUN1P HOUSE
GENERAL FEES Outdoor Li hfin Stand�d $1
SFR�ACFS I P(1WFR SI IPPI IFS Traffic Sianal Standard p SS ..
0 to 400 Ar
401 to 800
Above 800
;UITS I FEI
�, COMMUNICATION, REMOTE CONTROL, SIGNALING
ITS, CIRCUITS OF LESS THAN � VOLTS
ach System Device or Apparatus @ S.�
ADDITIONS TO THE GENERAL FEES
FAMILY DWELLINGS PER UNI
to 12 Unils @$50 Per Unit
ach Addition� Unit � 325
I IIII � III II fli II III II II) II �I II III II III !I III I IIII
14127948
Fee @ ;
ID �0 �O
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andla Power Supply up to 500 Amperes, All
Cirouits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips . 820
Investioative Fee __
TOTALFEE
(minimum rotal fee is $20) 40 . 50
r'us u�n Fon i�croa usE aar
1 herebY �P �� I inspecled Ne elec6ical install�on described hwein on the daffis sfa0ed:
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Request Date: Rcwphin Ir�specdon Required? Yes ❑ No Inspection Other Then Rough-In: OReady Pbw � WNI Cafl
You must call Me inspedor wF�en dyl Date Ready:
I certify ihat I am tt�e LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Jab Site Address ( BoX a Route No.) ZiP Code
FRIDLEY
�� NORTON AVE NE
l � �Q
324
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Contractor License Number Master DecVician or Power umrteo i ecmiaan
Lic�se Number
' IC INC. CA01936
a o� �r«�� ��ua,�,�
) AVE N BROOKLYN PARK MN 55428
pany or Owner Perfartning Insfallalion) Phane (s)
763 537-0807
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