P - 78662REQUEST FOR ELECTRICAL INSPECTION
1�`'� 1°� � 7 v g� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529 www•electriciry.state,mn.us
X NFW ❑ RFMODEL O ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
CIRCUITS OF LESS THAN 50 VOLTS
31012 Unifs � 350 Per Unit
Exh Addi6onal Unil � 825
Inl II I�I II �II II II) II III II III II (II II III �I � I IIII
1 4 1 2 7 8 9 8
Outdoor
ONE 8 TWO fAMILY DWELLINGS, EACH UNIT
Includes tt�e Service andlor Power Supply up to 500 Amperes, AI� $ 0
Circuits and Two Inspection Trips Each Dwelling Unit � EBU
(minimum total fee is 320) � �'°— O"'
T 115 ARE� FOR RiSPECTdt USE dlV
I herebY ceNfY that I inspec0ed Ihe ekctrica� inshdlaUOn desaibed herein on the da0as st�ed:
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Request Date: I RpupMin Inspedion Required?�Yes 0 No f Inspedion Other Than RougMn: UReady Now LJ WiH Call
� 6 � You must call the inspecta wh readyl ( Date Ready. .
I oertify ihat I am 1he ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of the electrical wak at:
Job Site Addr�s (Street a Route No.) Zip Code
1130 NORTON AVE NE FRIDLEY
PMJ HOMES
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XCEL ENER
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6324 LAKELAND,�p,VE N BROOKLYN PARK MN
BOARD OF ELECTRICRY COPV
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Lioense Number
55428
763-537-0807
�-00007M11 &1.2002