P - 79301� ❑ REQUEST FOR ELECTRICAL INSPECTION
�� 1 1�- 5 61 4 Minnesota B�ard of Electricity -
1821 Universit Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
�1 NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
.{GEL ENERGY �AVER'� SW'?'��±
GENERAL FEES Outdoor Liahtinq Standard (�a $1
SERViCES I POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A araius $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS fPER UNITI
Center Pivot
INSTALLATION MAY BE ORDERED DI
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1 7 7 3 5 6 1 4
Request Date: Rough�n Inspection Required7 LI Yes
��'�Q�Q� You must call the inspector when ready!
I certifyy tt�at I am ihe l�(LICENSED CONTRACTOR
Job Site Address (Street, 8ox, a Route No.)
6450 SQUIRE DR NE
Transformers u to 10 KVA $10
Transformers over 10 KVA .$ 20
Transformer I Power Supply for Signs I Oulline Lightinq @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTALFEE
(minimum total fee is $20) $20,50
THIS AREN FOR INSPECipi USE 011v �
I hereby certiy that I inspected the electrical installa6on described herein on tlie dates sUted:
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R � 2'71 : ,�
oRo -SC7
1 No Inspedion Other Than Rough-In: UReady Now U VYdI Call �
Date Ready:
❑ OWNER and hereby request inspection of the electricxl work at:
Zip Code
FRIDLEY 35432
PEHOSKI PATRIGIA A ( �
wer Supplier Power Suppli� Address
XGELENERGY
�tractor / Company Name ConVactor License Nurt
HUNT ELECTRIC CORPORATION CA 00883
iiling Address (Contractor, Company or Owner Performi�g InsfallaGon)
23(l0 TERRlTORIAL RbAQ ,^�AlP�'T �AlJL, P.4",� 5a11�
ANOKA
� �
nnaster Gecmaan a
License Number
�� �� � 65! 646-Z911 �
INBTRUCTIONS ON BACK OF VELLOW COPY BOARD OF ELEC7RIqTV COPY EB-00001MI4 8.7. 20U2