P - 81680� FfEQUEST FOR ELECTRICAL INSPECTION
�� 0 61 � 1( V � $121 Urover ity A eoue Su te'S 28, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529
wrvw. e lectricity. state. mn. us
Identity the work overed by this request:
❑NEW MODEL ❑ADDITION ❑REPAIR CAC Furnace
GENERAL FEES Outdoor Li htin Siandard �$1
SERVICES / POWER SUPPUES Traffic Si naI Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transtormers over 10 KVA �$20
CIRCUITS I FEEDERS Transformer ! Power Su I for Si ns / Outlirte L' hti �$5
0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ion Trips Each Dweilin Unft �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S stem Device or A aratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reinspedion Fee �$20
Retrofit � $25 per Fixture
�ivot Irrigation Boom � $4C
lured Home Park Lots � $
Mal Vehicle Park Sites � '
� Bonding Inspection (� $21
nspection � $30 per Hour
nsoection � $.31 oer Mile
TOTAL FEE J 2O. SO �
total fee is $20) I
I herebv certifv that I insoected the electrical insfellation daqcribed herein on tl�e dates stated:
FOR OFFICE USE ONLY
' IIIILI f ilfl IIIII Illll Illli II� CIIII IIII Illl
� 1 O 6 1 7 7 8 5�E
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COMPLETED WITHIN 18 MO�
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I certiiy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (SVeet, Box, or Route No.) Ciry �P �B
1581 Rice Creek Rd Fridley 55432
Range
IOccupant
Susie Tynjala
Phone
763-511-2530
Electrical Contrador / Company Name Contractor License Number
Total Electric Inc. CAO 2749
Mailing Address f(�' Vactor, Company or Owner Performing Installation)
10760 �'ankato St � Sui,�e_ 1 �
Number
►')'��(/(� i / //�/ �� I 763-786-8484 �
7/7/Zpp�l/ ' `�� BOMO OF ELECTRICfTY COPY INSTilUCT10NS ON BACK OF YELLOW COPY