P - 79270REQUEST FOR ELECTRICAL INSPECTION
�•,• 7 7 1.� � 2 8� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
` (651} 642-0800 TfY/MR5 1-800-627-3529 www.electricirystate.mn.us
❑ NEW O REMODEL ❑ AD ON 0 REPAIR Describe - g the 6ack of the white copy if ne�essary • the work overed by this request:
, � � _ , J�" • - - - - ��--
0 to 4D0 Ai
401 to 800
Above BOC
;UITS 1 FEI
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Each Additionat Unit
Canter
Standard
ONE & TWO FAMILY DWELLINGS, EAGH UNII
Includes ihe Service andior Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$BO
Reins tion Fee $20
T07AL FEE
(minimum totai fee is $20) Zd
,ws aeFw FoR uuvECroa use aa,
I hereby ceNfy that I inspected the electrical i�stallation described herein on 1M1e dates stated:
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Request Date: Rough-in Inspection Required? ❑ Yes Inspection Other Than Rough-In: eady Now ❑ wll Call
12-2.-�4 You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CON7RACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electdcal work at:
Job Site Address (SVeet, Boz, or Route No.} Ciry 7p e
6220 RICE CREEK� t��`��tCi FRIDLEY ___
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RICC.AR HEATiNG 'I.J� �� �T6:
'ower SuPPIi� Pox�er Suppiies ress
N/A X
;onUador ( Campany Name Contrador license 1
KOV.AR ELECTRIC LLC CA03644
dail'mg Address (Contractar, Company or Own� Performing InstalWtion)
23049 ARROWHEAD ST NW ST FRANCIS MN 55070
Wthatized Siacat�re (CAM2Ctor, Company or Owner�Perfomiing InstallationJ
Mester EIecU�aen or
Ut�13E Numbef
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WSTRUCTlON8 0M BACK OF YELLOW COPY BOARD OF EIECTRICYTY COPV E&OOU01M1I 8.1. T002