P - 78660REQUEST FOR ELECTRICAL INSPECTION
,�-� 12 - 7 9 5� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electricity.state.mn.us
� NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the b�k of the white copy if necessary - the work covered by this request:
GENERAL FEES Outdoor Li htin Standard $1
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
12 Units �
h AddiGonal
KVA
ONE 8 TWO FAMILY DWELLINGS, tacn um i
Includes the Service andlor Power Supply up to 500 Amperes, All 8 0
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTAL FEE I �`�' "—
(minimum total fee is $20) —�
THIS NREA FOR IIEPECTOR USE IXSV
I hereby certiy that I inspected the electrical installaGan described herein on ttie dates slated:
(��I II II� II III II III II III II �� I� (II II II� fl�� II�
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Request Date: Rough-in Inspection Required? es No Inspedion Other Than Rough-In: ❑Ready Now � VYII Call
5- 6- 0 3 You must call the fnspector when re dy! Date Ready:
I certify that I am the LICENSED CdNTRACTOR ❑COMPANY ❑ OWNER and hereby �equest inspection of ttie electrical wak at:
Job Site Address ( Box. w Route No.) Zip Code
1140 NORTON AVE NE FRIDLEY
PMJ
rer Supplrer
XCEL
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Signature (Co��r, Grnnpany or
BOARD OF ELEC'fRICITV COPV
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1936
PAKR
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Master FJectrician a P
License Number
55428
763 537-0807
EB-00001M14 8.7.20D2